The state’s largest health insurers are blaming Obamacare on substantial losses totaling $51.9 million in the first three months of the year.

Hawaii Medical Service Association, the state’s largest health insurer, reported a $30.4 million deficit in the first quarter, resulting from $59.1 million in fees related to the federal Affordable Care Act. That’s compared with a year-earlier loss of $57.2 million.

Meanwhile, Kaiser Permanente Hawaii, the second largest, said it posted a $21.5 million shortfall largely due to the $18.5 million it is paying in ACA fees and taxes. The health maintenance organization’s losses totaled $7.8 million in the year-earlier period.

Health insurers are required to record a year’s worth of ACA insurer fees in the first quarter. That means they tend to show a loss in the first quarter and do better over the remainder of the year since the ACA fees have already been paid.

Part of the ACA fees go to the federal government, which provides subsidies for low-income residents to make insurance more affordable. A portion of the money is transferred from Kaiser to HMSA, which had a sicker overall patient population.

A federal judge ruled this week that the Obama administration is unconstitutionally spending federal money to fund Obamacare without approval from Congress. If the decision is upheld, it could roil the health care law’s insurance markets, which are still struggling for stability after three years of the new system.

At issue is the $175 billion the government is paying to reimburse health insurers over a decade to reduce copayments for lower-income people. The disputed subsidies help lower-earning people afford out-of-pocket costs such as annual insurance deductibles and copayments when they visit doctors.

“ACA fees aside, our first-quarter financial results show the financial stability that Hawaii residents and businesses have depended on for 78 years,” said Michael Gold, HMSA president and chief executive officer, in a new release. “As one of Hawaii’s largest health plans, we’re responsible for the health care needs of more than half the people in our state. We carefully manage every dollar from members so they can see doctors and go to hospitals when they need to.”

HMSA, with 732,315 members, collected $782.6 million in premiums, compared with $727.3 million a year ago. Of that, $680.5 million went to medical benefits, compared with $656.4 million a year ago. HMSA’s administrative expenses rose to $73.6 million from $60.5 million. The result was a $30.6 million operating loss, down from $56.9 million a year ago. Income from investments totaled $3.2 million, up from $2.4 million last year. HMSA’s reserve fell to $339.95 million, or $464 per member, from $350.40 million, or $482 per member.

HMSA executives were unavailable for comment Friday but said in a statement that the increase in operating expenses was due primarily to the hiring of more than 200 health coaches, clinicians and managers from the insurer’s national contractor, Healthways Inc. The insurer said it transferred the employees to HMSA so they could work more closely “with doctors and hospitals to care for the thousands of HMSA members with serious illnesses.”

Kaiser, with 247,876 members, collected $336.2 million in dues revenue, up from $320.3 million, and spent $358.5 million on medical benefits, compared with $330.7 million a year ago. Operating losses totaled $22.3 million, up from $10.4 million. Investment income dropped to $800,000 from $2.6 million.

“We make sure folks get medical care — that’s why we have higher medical expenses,” said Thomas Risse, Kaiser’s chief financial officer. “We’ll see slightly higher rate increases going forward as we’re seeing medical expenses rise a little bit. This will affect the individual market more than the group market. That’s a newer population we’re finding that has higher medical needs than what their payments are covering.”

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The Associated Press contributed to this story.