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Health insurance costs are skyrocketing throughout most of the U.S. Obamacare insurance premiums for 2017 jumped by double-digit percentages in 31 states. The average increase was a whopping 25%. 

Some states have especially high health insurance costs. The U.S. Department of Health and Human Services (HHS) calculated monthly premiums assuming a 27-year-old purchased the second-lowest cost silver plan on the Obamacare exchange. Here are the six states where the monthly premium is more than $400.

Nebraska welcome sign

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The average monthly cost of a typical health insurance premium in Nebraska is $411. That's 51% higher than the average premium paid by Cornhusker State residents in 2016. A family of four in Nebraska would pay $1,487 per month for similar coverage.

There are only two available Obamacare plans available in Nebraska -- Aetna (NYSE:AET) and Medica. Blue Cross Blue Shield of Nebraska, the state's largest health insurer, pulled out of the Obamacare marketplace after losing $140 million from 2014 through 2016. UnitedHealth Group (NYSE:UNH), the largest health insurer in the U.S., also exited the Nebraska exchange as part of a broader pullback from Obamacare.

Why are premiums so high in Nebraska? Prior to its decision to exit the state's Obamacare marketplace, Blue Cross Blue Shield of Nebraska said the problem boiled down to higher-than-expected healthcare utilization. 

Wyoming welcome sign

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The hypothetical 27-year-old purchasing a silver Obamacare plan in Wyoming would pay $413 per month in health insurance premiums -- 9% higher than the rate in 2016. A family of four with the same silver plan would pay $1,487 per month.

Wyoming has only one insurance company offering coverage through the Obamacare exchange: Blue Cross Blue Shield of Wyoming. The state held that distinction by itself in 2016. However, for 2017, four other states joined the single-insurer club.

Wyoming fits the general profile of states that have extraordinarily high premiums. It's heavily rural with a small population. Wyoming also didn't expand Medicaid with federal assistance provided through Obamacare.

Arizona desert sunset

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The monthly cost for Obamacare premiums for a 27-year-old in Arizona is $422. That's only a little higher than the rate for Wyoming. However, unlike Wyoming, Arizona's health insurance premiums soared in 2017 -- increasing 116%. 

That huge jump is the largest of any state in the country. When Obamacare first started, Arizona had eight health insurers participating with some of the lowest premiums of any state. Now, that number has dwindled to just two -- Blue Cross Blue Shield of Arizona and Health Net, which was acquired by Centene (NYSE:CNC) in 2016.

The problem in Arizona is similar to those in other states. Younger, healthier individuals aren't enrolling as much as sicker patients who cost health insurers a lot of money. As the losses mounted, health insurers pulled out of the state -- with rates skyrocketing.

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An Oklahoman 27-year-old would need to shell out $424 per month to buy the second-lowest cost silver Obamacare plan. That's 69% higher than the monthly premium in 2016. A family of four would spend $1,536 each month for similar coverage.

As is the case in Wyoming, only one health insurer participates in the Obamacare marketplace in Oklahoma. Also like with Wyoming, that one participant is the state's Blue Cross Blue Shield plan.

Blue Cross Blue Shield of Oklahoma has offered coverage through the state's Obamacare marketplace since 2014. During the past three years, the insurer has accumulated losses of more than $300 million as a result of its participation. 

North Carolina state flag

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North Carolina

The Tar Heel State claims the dubious distinction of having the second-highest health insurance premiums in the country with individual coverage for the standard plan used by HHS costing $446 per month. The monthly premium for a family of four in North Carolina is $1,613. 

There are two participating insurers in the North Carolina Obamacare marketplace following the withdrawal of UnitedHealth Group and Aetna. But residents in most of the state's counties will only have one plan from which to choose -- Blue Cross Blue Shield of North Carolina.

Cigna (NYSE:CI) is the other insurer participating in the state's Obamacare exchange. However, the company opted to offer plans in only five counties in North Carolina's growing Research Triangle region. 

Byers Lake and Denali, Alaska

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Alaska is the top state on a map of the U.S. -- and it's also at the top of the list of states with the highest health insurance costs. Obamacare premiums for single coverage in Alaska are a whopping $760 per month. For a family of four, that cost jumps to $2,750.

Only one insurer participates in the state marketplace -- Premera Blue Cross. Premera lost so much money from its Obamacare plans in 2015 that the Alaskan legislature had to shift money to essentially bail the company out so that it could continue to provide coverage.

The challenges that Premera Blue Cross faced in the past aren't likely to be resolved anytime soon. There simply aren't enough healthy members in the Alaskan market to offset the costs of others with high medical costs.  

Health insurance form with piggy bank, change, and calculator

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What does the future hold?

Some might argue that the federal subsidies help reduce the actual amount of premiums paid by many Americans. That's true. However, the fact remains that many still must pay the increasingly high monthly amounts. 

The health insurers that continue to participate in Obamacare marketplaces won't be able to sustain losses indefinitely. Either the federal government will have to fix Obamacare or replace it with something else. Which alternative will be chosen is still up in the air.

This article represents the opinion of the writer, who may disagree with the “official” recommendation position of a Motley Fool premium advisory service. We’re motley! Questioning an investing thesis -- even one of our own -- helps us all think critically about investing and make decisions that help us become smarter, happier, and richer.