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A federal appeals court on Friday left in place a decision blocking Blue Cross-Blue Shield insurer Anthem’s bid to buy rival Cigna, saying that a bigger company is not better for consumers. The 2-1 decision upholds a federal judge’s ruling in February that said the proposed $48 billion acquisition would further reduce competition in the already concentrated health insurance market. Anthem argued the combination would save $2.4 billion in medical costs and lead to lower consumer premiums. But the Justice Department said Anthem had no real plan to reach those savings. (Hananel and Murphy, 4/28)

The decision is a likely final blow to Anthem’s bid to complete the $48 billion merger, which a lower-court judge had said should be stopped because it risked undermining competition in health-insurance markets. The two companies have since sued one another, with Cigna seeking a $1.85 billion breakup fee and Anthem blaming its rival for undermining its legal defense of the deal. (McLaughlin and Harris, 4/28)

"We hold that the district court did not abuse its discretion in enjoining the merger based on Anthem's failure to show the kind of extraordinary efficiencies necessary to offset the conceded anticompetitive effect of the merger in the 14 Anthem states: the loss of Cigna, an innovative competitor in a highly concentrated market," the opinion, penned by Judge Judith Rogers, states. (Livingston, 4/28)

In a statement released late Friday Anthem said, “We are committed to completing the transaction and are currently reviewing the opinion and will carefully evaluate our options.” Anthem still has the option of trying to save the deal by asking the appeals court to re-consider the case or appealing straight to the U.S. Supreme Court. (Radelat, 4/28)