BILL HEMMER (HOST): News that Aetna, late last night, is pulling out of Obamacare exchanges in the state of Nebraska and Delaware -- the last two states where it even offered coverage. Dr. Ezekiel Emanuel, chair of medical ethics and health policy at the University of Pennsylvania, Obamacare architect, Fox News contributor. Doctor, good morning to you and welcome back here to America's Newsroom. This is a tough one. How do you explain it, how do you defend it now?

EZEKIEL EMANUEL: Well, Aetna has had a very small footprint. In Delaware it's had only 12,000 people insured. But let's get to the big picture. The big picture is, as they said and other insurers have said, we need the government to do several things. One is to guarantee that they'll pay the cost sharing subsidies, those are subsidies to people to cover deductibles and to cover co-payments up to $60,000 for a family.And the government and Speaker Ryan, in particular, has said that's got to be part of appropriation, but we're not going to put it--

HEMMER: That's got nothing to do with them right now, though. This is under Obamacare, has nothing to do with what the House Republicans did last week.

EMANUEL: No, no, no. You're absolutely wrong because this is for 2018, and 2018 they have to put their rates in now, and the government has been uncertain. And the one thing insurance companies hate is uncertainty. And Speaker Ryan has made sure that they're uncertain. He is holding the bag, he's responsible for this leaving. And it's the Republicans being responsible.

[CROSSTALK]

HEMMER: I got it, doc. I got it. Let me just go back to what Aetna said, OK? This [is] what the spokesman said, this is their writing now, OK? On screen, “Our individual commercial products lost nearly $700 million between 2014 and 2016 and are projected to lose more than $200 million in 2017 despite a significant reduction in membership.” I don't know what that has to do with Paul Ryan right there. They are covering fewer people--

EMANUEL: I'll tell you--

HEMMER: They are covering fewer people and losing more money because of it.

EMANUEL: I'll explain it to you.

HEMMER: Your witness, go.

EMANUEL: Look, you go in -- Any retailer goes into a market, they expect to lose right at the start because they are investing, they are investing in administrative procedures, and in the insurance industry you don't know who is coming in. So they had a hard time pricing their product because they didn't know who would show up OK? You expect that loss. That is built into your situation. The problem going forward, and the problem now is we're talking about entering the market or keeping in the market for 2018, is the uncertainty today. That uncertainty today is created by the Trump administration because they haven't done three fundamental things.

Number one: Said they are going to enforce the mandate, which is why you see 3 or 4 percent of people not buying insurance. Number two: These cost-sharing subsidies, saying they are going to pay them. If they don't pay, them the insurance companies have to pay them and they will be at a significant -- tens of billions of dollars -- financial loss. And third: What's called reinsurance or risk corridors, that's to help the insurance companies when they get a bad risk selection. Those three things, everyone has said and the Republicans agree, are necessary to stabilize the market. They haven't done them.

[CROSSTALK]

EMANUEL: Let me finish. They haven't -- I want to conclude the argument. They haven't done those, insurance companies see uncertainty and therefore they either raise the rates or they leave the marketplace. And that's what you're seeing, the Republicans are at fault on this.

Previously:

The GOP Health Care Bill Actually Does What Conservatives Said Obamacare Would Do -- And Worse

Right-Wing Media Ignore Role Of Subsidies, Claim Insurance Premium Increases Are A “Death Spiral” For Obamacare

Fox Resurrects Obamacare “Death Spiral” After News Of Aetna’s Withdrawal From Insurance Exchanges