As negotiations on the long-awaited healthcare reform fell apart last month, President Trump predicted the collapse of the Affordable Care Act. Obamacare, he said, would implode. And that process continues. Anthem has announced that it is pulling out of another state’s insurance exchange.

Nevada is sparsely populated and this had already limited the choices for coverage in the state. But Anthem, who provides Blue Cross Blue Shield coverage, was one. But they plan to pull out in 2018.

According to Business Insider, the provider had already announced that they would not provide coverage in 14 of Nevada’s counties, and have now pulled out of the other 3.

Clark, Washoe, and Nye counties (the most heavily populated counties) will still have options. the rest of the state, though, now has no coverage plans.

“While the Division is disappointed in Anthem’s latest decision regarding its withdrawals, we believed that it was in the interest of the Nevada public to let consumers know about the Anthem decision as soon as possible,” Barbara Richardson, Nevada’s insurance commissioner, wrote in a statement.  “The Division is continuing to work with our state partners on attracting an insurance carrier to serve the 14 bare counties and to support the stability of the market for those insurance carriers who remain.”

“Based on the rate submissions the Division of Insurance received from Anthem, they proposed an average rate increase of 62%,” Richardson said. “This proposed rate increase did not reflect the potential elimination of payments to insurance carriers for Cost Share Reductions (CSRs). Loss of the Cost Sharing Reduction payments has the potential to increase further rates in the Nevada market.”

Anthem is blaming the uncertainty on the President’s rhetoric and threats about the implosion or the program.

“Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage,” their statement said.

This latest move may well foreshadow what’s to come. Theirs an August deadline for contracts. Nevada, Wisconsin, ohio, and Indiana are all facing counties with no providers.