FORT LAUDERDALE, Fla. — Centene announced it will offer health insurance plans on Florida’s Affordable Care Act exchange for the first time, joining Florida Blue and Molina, who will also remain in the market. This week’s news comes as several insurers have pulled out of the exchange amid uncertainties about subsidies and other changes under a Republican replacement.

Centene is expanding its footprint in Florida, Georgia, Texas and a handful of other states and is entering the market for the first time in Kansas, Missouri and Nevada, while earlier this year Humana said it was pulling out due to the unstable risk pool. A spokeswoman for Molina said in an email Friday that it planned to file rates to continue offering plans in Florida next year but declined to elaborate on whether it would be expanding or shrinking their territory. Their plans are currently offered in eight Florida counties, including Miami-Dade, Palm Beach, Broward, Hillsborough and Osceola, said spokeswoman Leigh Woodward.

The Sunshine State has led the country in enrollment on the Affordable Care Act exchange with nearly 1.7 million consumers.

“Centene recognizes there is uncertainty of new health care legislation, but we are well positioned to continue providing accessible, high quality and culturally-sensitive health care services to our members,” CEO Michael F. Neidorff said in a statement.

Premium increases are likely, but the specific numbers are not available yet since insurers are not required to file their rate requests with the state until next week. The vast majority of Florida exchange consumers, more than 1.2 million, receive subsidies to help pay for their health insurance, but President Donald Trump has threatened to do away with the payments. The tremendous uncertainty has spooked some insurers out of the marketplace.

Trump, who has promised to make health care more affordable, celebrated the passage of the House health bill, but recently he’s told senators it’s too “mean,” and he’s urged lawmakers to spend more money on health care. A recent government report finds that out-of-pocket costs — deductibles and copayments — would average 61 percent higher under the House Republican bill. Premiums would be lower, but consumers would actually end up paying more on average because government financial assistance would be curtailed, according to a report this week from the Office of the Actuary, a nonpartisan economic unit at the Health and Human Services Department.

Florida Blue warned their rates would increase by an additional 20 percent on average across the state without the cost sharing reductions.

“This funding helps those who need the most help accessing high-quality and affordable care, and is a crucial element to health care reform that allows us to provide a variety of plans for current and future Florida Blue members,” the company said in a statement.

Florida Blue is the only provider offering plans in all 67 Florida counties and is the sole provider in several mostly rural counties, largely in the Panhandle and along the Florida-Georgia border.

The Trump administration released a map this week to support their continued allegations that the Affordable Care Act is in a death spiral by showing counties where they predict consumers will have zero or only one insurer.

Florida had more than a dozen counties with only one insurer to choose, according to the map by the Centers for Medicare and Medicaid Services. Trump health officials predicted that nearly 40 percent of counties nationwide or 1,200 counties could have only one issuer in 2018.

“This is yet another failing report card for the exchanges. The American people have fewer insurance choices and in some counties no choice at all,” CMS Administrator Seema Verma said in a statement, adding they are working on restoring access to plans but that their actions were not long-term solutions.

But health policy experts warn that’s not an accurate picture, arguing there are plenty of urban spots around the country including South Florida with multiple insurers to choose from.

“You can’t damn the whole problem when the story you’re telling isn’t really true in the urban centers and is only true in less populated areas,” said John Holahan of the Urban Institute think tank. “Those less populated areas before the (Affordable Care Act) typically had only one insurers anyway so it hasn’t gotten worse and if the ACA went away that’s probably the world that would exist.”

Some experts have suggested solutions like a government-run plan that would be automatically instated in counties where there’s only one insurer or a mechanism that sets rates for all the carriers (similar to Medicare Advantage) so they don’t have to worry about coming in and negotiating with each provider.

“Monopolies have developed and rather than dealing with that problem (the federal government) is using them to say Obamacare is in a death spiral and permanently flawed,” said Holahan.