Near­ly half of the 17 insur­ance mar­ket­places set up by the states and the Dis­trict under the ACA are strug­gling finan­cial­ly, which cre­ates even more pres­sure on the upcom­ing Supreme Court deci­sion over the fed­er­al exchanges. Ore­gon is already out but Con­necti­cut is suc­ceed­ing, and there are a lot in between, but most­ly lean­ing toward fail­ure. Signups for the state mar­ket­places rose a dis­ap­point­ing 12% while those in the fed­er­al exchange rose 61%. In Min­neso­ta and Ver­mont offi­cials are so fed up with cost­ly tech­ni­cal prob­lems that they are con­sid­er­ing hand­ing over some or all of their func­tions to the state or fed­er­al gov­ern­ments. In Rhode Island, the leg­is­la­ture is con­sid­er­ing a fee on health plans that would rise or fall depend­ing on how costs go, and in Hawaii they already need anoth­er $28 mil­lion to fund oper­a­tions until 2022.