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A federal judge ruled on Monday that a $37 billion merger between the health insurance giants Aetna and Humana should not be allowed to go through on antitrust grounds, siding with the Justice Department, which had been seeking to block the deal. (Abelson and Picker, 1/23)

U.S. District Judge John Bates said in an opinion filed Monday that federal regulation would probably be "insufficient to prevent the merged firm from raising prices or reducing benefits," and neither new competitors nor an Aetna plan to sell some of the combined company's business to another insurer, Molina Healthcare Inc., would be enough to ease competitive concerns. (Murphy, 1/23)

The ruling is a victory for antitrust enforcement efforts initiated by the Obama administration. It may bode poorly for the planned $48 billion merger between Anthem Inc. and Cigna Corp., which was challenged by the Justice Department and is awaiting a ruling. Shares of all four companies declined. (McLaughlin, Tracer and Harris, 1/23)

Although the antitrust decision can be appealed, the outcome could have significant ramifications on how older Americans purchase government Medicare and private Medicare Advantage coverage in the rapidly changing U.S. healthcare market, as well as on the options available to individuals who don't have employer coverage. (McCoy, 1/23)

"We are reviewing the opinion now and giving serious consideration to an appeal, after putting forward a compelling case," Aetna spokesman T.J. Crawford said. The companies' merger agreement, which has already been extended twice, will expire Feb. 15. (Johnson, 1/23)

“Elderly patients were the big winners today as a federal court imposed an injunction on Aetna’s $37 billion acquisition of Humana,” the American Medical Association, which opposed the merger, said in a statement. (Sullivan, 1/23)

The Justice Department sued last summer to block the Aetna deal as well as Anthem’s separate, $48 billion purchase of Cigna. Both cases went to trial late last year. An opinion has yet to be rendered for the Anthem case. (Liss, 1/24)

The government’s challenge to the merger was among the last major law-enforcement actions taken by Obama administration antitrust officials. The administration also challenged Anthem Inc.’s proposed acquisition of Cigna Corp., and a ruling in that case is expected any day. Together the deals could have transformed an industry already facing uncertainty from Republican plans to dismantle the Affordable Care Act and replace it with another health-care plan. (Kendall and Wilde Matthews, 1/23)

Under the terms of the merger, Aetna will have to pay Humana a $1 billion “break-up” fee if the deal does not go through. The companies’ merger agreement, which has already been extended twice, is due to expire on February 15. (Radelat, 1/23)