Nearly a third of the nation’s counties look likely to have just a single insurer offering health plans on the Affordable Care Act’s exchanges next year, according to a new analysis, an industry pullback that adds to the challenges facing the law.

The new study, by the nonpartisan Kaiser Family Foundation, suggests there could be just one option for coverage in 31% of counties in 2017, and there might be only two in another 31%. That would give exchange customers in large swaths of the U.S. far less choice than they had this year, when 7% of counties had one insurer and 29% had two.

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The tanning salon industry is feeling burned by “Obamacare.”

Business owners around the country say the little-noticed 10 percent tax on tanning in President Barack Obama’s health care overhaul has crippled the industry, forcing the closing of nearly 10,000 of the more than 18,000 tanning salons in the U.S.

Experts say the industry is overstating the effects of the “tan tax” and that it has been hurt by other factors, too, including public health warnings about the dangers of tanning and the passage of laws in dozens of states restricting the use of tanning salons by minors.

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Health insurance startup Oscar Insurance Corp. will reevaluate its approach to Obamacare after suffering significant losses under the U.S. program and will pull out of two markets next year.

Oscar, which pitches itself as a tech-savvy alternative to traditional health insurers, plans to end sales of Affordable Care Act plans in Dallas, a market it entered this year, and New Jersey. It’s part of a more conservative approach by the New York-based company as it plans to introduce insurance products for businesses next year.

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Barack Obama’s signature health-care law is struggling for one overriding reason: Selling mispriced insurance is a precarious business model.

Aetna Inc. dealt the Affordable Care Act a severe setback by announcing Monday it would drastically reduce its participation in its insurance exchanges. Its reason: The company was attracting much sicker patients than expected. Indeed, all five of the largest national insurers say they are losing money on their ACA policies and three, including Aetna, are pulling back from the exchanges as a result.

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An Arizona county is poised to become an Obamacare ghost town because no insurer wants to sell exchange plans there.

Aetna’s recent announcement that it would exit most of the states where it offers Obamacare plans leaves residents of Pinal County, Arizona, without any options to get subsidized health coverage next year, unless regulators scramble to find a carrier to fill the void between now and early October.

About 9,700 people in Pinal signed up for Obamacare plans this year, according to administration data.

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Last November, when UnitedHealth Group said it expected to post big losses on its Obamacare policies in 2016, rivals such as Anthem and Aetna signaled their Affordable Care Act businesses were doing fine. The Obama administration used that as evidence to refute claims that systemic problems were brewing in its landmark insurance program.

Now, there’s no denying it. The four biggest U.S. health insurers admit they’re each losing hundreds of millions of dollars on their Obamacare plans. Rather than expand coverage, many are pulling out of the exchanges that were set up by the ACA so people can shop for insurance plans, often with the help of government subsidies.

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Aetna, one of the nation’s largest health insurers, announced Monday it is pulling out of all but four state exchanges in 2017. It is currently offering exchange plans in 15 states.

Aetna is only the latest insurer to reduce its marketplace presence, citing losses. The news also comes amid reports of double-digit premium hikes next year, another sign of financial trouble for insurers. Most of the nonprofit co-op plans created under the health care law have also shuttered.

“Following a thorough business review and in light of a second-quarter pretax loss of $200 million and total pretax losses of more than $430 million since January 2014 in our individual products, we have decided to reduce our individual public exchange presence in 2017, which will limit our financial exposure moving forward,” said Aetna chairman and CEO Mark Bertolini in a statement.

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Blue Shield of California is shutting down for the four days after Labor Day to reduce its payroll-related liabilities, citing losses in California’s Covered California Obamacare exchange and other commercial and individual lines of business.

The move will affect most of its 6,000 employees in California, except about 1,000 who work for Care1st, which it acquired last fall for $1.2 billion, and some staffers in customer service and related areas who will remain on the job. The exact number of workers involved hasn’t yet been tabulated, according to the San Francisco-based insurer.

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After the Affordable Care Act took effect in 2010, it created a review mechanism intended to prevent exorbitant increases in health insurance rates by shaming companies that sought them.

But this summer, insurers are turning that process on its head, using it to highlight the reasons they are losing money under the health care law and their case for raising premiums in 2017.

That has ignited an election-year fight between insurers and consumers, who are complaining bitterly about the double-digit increases being sought across the country.

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Hillary Clinton admits she’s running to extend the Obama legacy, and so far she’s had a free ride in defending it. She hasn’t even had to explain the increasingly obvious failures of ObamaCare to deliver the affordable insurance that Democrats promised.

The Affordable Care Act is now rolling into its fourth year, and even liberals are starting to concede that the insurance exchanges are in distress and Congress may have to reopen the law. Premiums are high and soaring; insurers have booked multimillion-dollar losses and are terminating plans; and the customer pool is smaller, older and less healthy than the official projections.

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