Another health insurer — Aetna — has reported losses on its Affordable Care Act business.

While the Hartford, Conn.-based firm’s overall net income rose 12% in the fourth quarter, to $320.8 million, or 91 cents a share, it lost money on its ACA business in 2015, with a negative margin of around 3% to 4% for the year.

Aetna beat Wall Street earnings estimates on the strength of its business that sells Medicare and Medicaid health plans. But the insurer’s CEO, Mark T. Bertolini, said that the company has “serious concerns about the sustainability of the [ACA’s] public exchanges,” and wants to see regulators step up their efforts to improve the ACA marketplaces for insurers.

At year-end, Aetna had roughly 1 million customers enrolled in individual health plans — three-quarters of those through the ACA exchanges. The company hopes the individual health-care plan business will break even in 2016 after the insurer withdraws from some states and raises rates in others.

Other insurers’ earnings have also been dragged down by the ACA business, according to The Wall Street Journal. Anthem said it roughly broke even in 2015 on individual plans, and it expects a profit in 2016, but below its target margin of 3% to 5%.

“Last month, UnitedHealth Group deepened its projected losses for 2016 ACA plans to more than $500 million, part of which it booked as a portion of its 2015 results, and said it had losses of about $475 million on its 2015 ACA-plan business,” the WSJ wrote. “It has said it would consider withdrawing from the health-law marketplaces, a decision expected to be made later this year.”

Humana, which Aetna agreed to acquire last year, will also likely disclose losses on its 2015 ACA exchange business when it reports earnings on Feb. 10, according to the WSJ.

Despite the losses, an average of 10 insurers per state are offering plans for 2016, up from nine in 2015 and eight in 2014, according to USA Today. And not all health insurance executives are as pessimistic about the public exchanges as Bertolini.

“At Kaiser Permanente, we remain strongly committed to continuing to participate in the health exchanges,” CEO Bernard Tyson said in an emailed statement to USA Today last November.  “While there have been challenges at times, we believe at the end of the day they are causing healthy disruption, and are forcing the health care industry to respond better to consumer needs.”

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