High costs and disappointing enrollment are plaguing some state-run health insurance markets, according to an Associated Press report. The spiraling costs and low sign-up numbers could lead some states to turn operations over to the federal government or join with other states.Twelve states [California among them] and the District of Columbia fully control their health insurance exchanges, according to the AP. Of those, experts estimate about half are in financial trouble.

Hawaii’s marketplace, for instance, was awarded $205 million in federal startup grants. The state spent about $139 million and enrolled 8,200 customers for individual coverage this year. Hawaii’s marketplace has turned out to be unsustainable, and will turn over sign-ups to the federal government for 2016, the AP reports.

“The viability of state health insurance exchanges has been a challenge across the country, particularly in small states, due to insufficient numbers of uninsured residents,” said a statement from the office of Hawaii Gov. David Inge.

Federal grants to states for healthcare exchanges totaled nearly $5 billion, according to the AP. Most of that money has now been spent. But now that the Supreme Court has ruled that the federal government can continue to subsidize premiums in all 50 states, there’s no longer a risk in turning to the feds for help, the AP reported.

States could also pool resources on such things as call centers or use HealthCare.gov’s technology for online enrollment, according to the AP.