Insurance company Anthem on Wednesday said it could pull back on its participation in ObamaCare in 2018 if changes are not made to make the market more sustainable.

Other large insurers, such as Aetna, UnitedHealthcare and Humana, have already pulled back, citing financial losses on the ObamaCare marketplaces from a smaller and sicker group of enrollees than expected.

In 2018, Anthem says it could join its rivals. Like the others, Anthem could drop off in some areas while staying in others.

“We believe that we must see adjustments such that we can easily map to a 2018 situation of sustainability in this marketplace, and quite frankly given what may or may not happen, we’ll be evaluating the regional engagement across our markets moving into 2018,” Anthem CEO Joe Swedish said on an earnings call.

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