Missouri regulators oppose Aetna-Humana merger

Missouri has become the first state to oppose the Aetna-Humana merger deal, which has gotten a green light from several other state regulators as it continues to undergo a federal review.

In a preliminary order, Missouri Department of Insurance Director John Huff writes that if Aetna and Humana's deal eventually closes, the company and its subsidiaries must "cease and desist" from doing business throughout the state in the comprehensive individual, comprehensive small-group and group Medicare Advantage markets.

In the individual MA market, Aetna-Humana would have to stop doing business in certain counties in Missouri that the state has determined would be adversely affected by competition.

"Aetna and Humana failed to demonstrate that traditional Medicare operates as a competitive constraint in the Medicare Advantage market," the order states.

The insurers have 30 days to submit a plan to remedy what Missouri identifies as the anticompetitive impact of the acquisition, after which Huff can choose whether to finalize the order.

Past reports have warned that the merger between Aetna and Humana will further consolidate an MA market that already has little competition, and that divestitures may not be enough to mitigate the anticompetitive effects. Indeed, nearly three-quarters of MA plans are dispersed among the country's largest insurers: UnitedHealthcare, Humana, Aetna, Blue Cross Blue Shield (excluding Anthem), Cigna and Kaiser Permanente.

Aetna CEO Mark Bertolini has argued that a combined company would still control only 8 percent of the Medicare market. As enrollment in MA plans continues to steadily rise, though, Humana's market share in the sector was a "compelling" reason for Aetna's interest in acquiring it, Bertolini has said.   

To learn more:
- here's the order

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