Realities of the Affordable Care Act (ACA) are Taking Hold Across the U.S. and in NM: Realities of the Affordable Care Act (ACA) are Taking Hold Across the U.S. and in NM: Part of the federal healthcare program referred to as Obamacare provided guidelines for each state to establish healthcare exchanges. NM was one of the states that 'opted in' and chose to set up an ACA state exchange. Now, several state programs including Minnesota, Maryland, Vermont and Oregon are experiencing problems that affect policy holders. Hawaii completely shut their state exchange down. Here in New Mexico, Blue Cross Blue Shield Here in New Mexico, Blue Cross Blue Shield (BCBS) announced it would pull out of the state health exchange beginning January 1 of 2016. After losing more than $19.2 million, BCBS requested a 51.6 percent average premium increase that was denied. BCBS felt there was no alternative other than to pull out of the state exchange program.