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Anthem Inc. on Thursday appealed a federal judge’s decision to block its acquisition of Cigna Corp., but the future of the deal was unclear amid discord between the two partners. On Wednesday, U.S. District Judge Amy Berman Jackson said the proposed $48 billion deal between the two health insurers violated federal antitrust law because it would create an unacceptable reduction in the number of companies able to serve large multistate employers that offer insurance to their workers. (Wilde Mathews, 2/9)

In her ruling, Judge Amy Berman Jackson of the D.C. District Court sided with antitrust regulators in saying the merger would lead to a domination of employer-provided health coverage in the U.S. (Hellmann, 2/9)

“The company promptly intends to file a notice of appeal and request an expedited hearing of its appeal to reverse the Court’s decision so that Anthem may move forward with the merger, which was approved by over 99 percent of the votes cast by the shareholders of both companies,” Anthem said in a statement. (Radelat, 2/9)

Anthem and Cigna may have one fight left. Their $54 billion deal was nixed on Wednesday by a federal judge, who agreed with the Justice Department’s concerns about competition. In addition to fighting the government, the two health insurers had been squabbling with each other over the merger. That suggests that the payment of the breakup fee could be contentious, too. (Cyran, 2/9)

The relationship between Anthem and Cigna has deteriorated since the deal was struck a year and a half ago and even factored into the judge's decision. U.S. District Judge Amy Berman Jackson wrote that the animosity between the two was “the elephant in the room.” (Livingston, 2/9)

Although judges shot down Anthem Inc's $54 billion acquisition of Cigna Corp and Aetna Inc's $35 billion takeover of Humana Inc on anti-trust grounds, the rulings left scope for a possible combination of Cigna and Humana, industry insiders said. Cigna would have both the motives and finances to pursue an acquisition of Humana, these experts suggested. Because of its much smaller Medicare Advantage business, Cigna may have a better shot at winning a regulatory green light, they added. (O'Donnell, 2/9)

The Big Five are still the Big Five. After two years of merger talks, blockbuster deals and legal fights, the same five companies still dominate the national health insurance market. And despite being thwarted by courts, their push to consolidate in friendly or hostile deals remains strong, as the companies seek to exert leverage in negotiations with hospitals and doctors. (Demko, 2/9)

The proposed $48 billion merger between insurance giants Anthem and Cigna looks like it's dead, as does the $37 billion deal between Aetna and Humana, though Aetna said it will appeal. In both cases, federal judges ruled the mergers would hurt consumers, eliminating competition and driving up prices. So what now for four of the nation's five largest health insurers? These companies have billions on hand, and they've got to do something with it. (Gorenstein, 2/9)