The proposed merger between major health insurers Aetna Inc. and Humana Inc. continues to inch closer to finalization. In a recent press release, Aetna announced that 10 states have now signed off on its proposed acquisition of Humana. The most recent approval came from Florida’s Office of Insurance Regulation (OIR) on February 15, 2016. In its consent order, Florida’s OIR concluded that the combination of Aetna and Humana would not prejudice policyholders or the public, substantially lessen competition, or create a monopoly. Although Florida’s OIR imposed some conditions on Aetna and Humana as a condition of its approval, it did not require Aetna or Humana to divest any policies or affiliates in the state.

Despite this important victory, obstacles to the proposed Aetna and Humana merger still remain. According to Aetna, an additional 10 states still must approve the deal. In addition, the Antitrust Division of the United States Department of Justice continues to review the proposed Aetna-Humana merger, as well as the proposed acquisition of Cigna Corp. by Anthem Inc. The attorneys general from several states have joined the Justice Department’s antitrust investigation into these two proposed mergers. Also, the American Medical Association (AMA) and American Hospital Association (AHA) have both sent letters to the Justice Department objecting to the proposed combination of Aetna and Humana and Anthem and Cigna, arguing that this consolidation would substantially lessen competition and harm consumers.

If the Justice Department concludes that the proposed Aetna-Humana merger violates federal antitrust law, it could file a lawsuit to block the merger. Alternatively, and as Aetna acknowledged in its recent press release, the Justice Department may require Aetna and Humana to divest some of their assets in some geographies before approving the deal.

The proposed Aetna-Humana merger was publicly announced last July and approved by the companies’ respective shareholders in October. Aetna has publicly stated that it expects the transaction to close in the second half of 2016. If the proposed mergers between Aetna and Humana and Cigna and Anthem are finalized, the number of major health insurers in the United States will decrease from five to three. Because the proposed Aetna-Humana and Cigna-Anthem mergers continue to be evaluated by antitrust regulators, organizations that may be impacted by these or similar combinations still have the opportunity and right to comment and provide their opinion on potential impacts to the organization’s operations, overall competition and the public.