New York state and federal regulators ordered the U.S.’s largest nonprofit health insurance provider established under the Affordable Care Act, the Health Republic Insurance of New York, to shut its doors by the end of the year as it continues to trend toward insolvency.

The announcement Friday disrupts health coverage for more than 200,000 people.

The Health Republic Insurance of New York received more than $265 million in taxpayer-funded loans, according to the Centers for Medicare and Medicaid Services. It is too early to know how much the company will be able to repay.

“While we are deeply disappointed with this outcome, we believe it is in the best interests of our members,” the group said in a statement Friday, adding that the structure of ACA’s co-op program created challenges “too difficult to overcome.”

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