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A $48-billion deal that would create the nation's largest health insurer inched closer to completion after shareholders of both Anthem and Cigna voted in favor of a buyout. The companies said that nearly all of their shareholders approved the deal, announced last July, when Blue Cross-Blue Shield coverage provider Anthem said it would pay $103.40 and a portion of its stock for each Cigna share. The boards of both companies have already approved the deal, and shareholder backing was widely expected, but the acquisition still has one more key hurdle to clear. (12/3)

The Anthem and Cigna marriage comes amid unprecedented consolidation in the healthcare industry and among health plans in particular. This summer, Aetna (AET) announced plans to buy rival Humana (HUM) for nearly $40 billion. And while Aetna and Humana shareholders signed off on that deal less than two months ago, it has yet to be cleared by antitrust regulators either. (Japsen, 12/3)

Both federal and state regulators are reviewing the combination, which would create an insurance company that would cover more than 50 million people. This deal and a proposed merger of Aetna and Humana have raised anti-trust concerns in part due to the negotiating leverage that the bigger insurers might gain over entities like health care providers. The insurers have said that the combinations pose little threat to competition because plenty of rivals will remain in individual markets. (12/3)

Anthem shareholders are so in favor of buying Cigna. 99 percent of Anthem Inc. shareholders voted Thursday to take the critical step of issuing shares to carry out the $54 billion acquisition. It's one of the biggest mergers in the history of the health insurance industry, and it stands to make Indianapolis-based Anthem one of the few remaining powerhouses in an industry that's rapidly consolidating. (Swiatek, 12/3)