With the long-awaited merger of giants Anthem and Cigna announced, the impact on the newest market segment in health insurance might could be significant.

On paper, Anthem and Cigna have a limited exchange presence ? Anthem sells in the 14 states where it operates Blue plans, Cigna only sells in eight. In enrollment, Anthem is the nation's largest exchange player, with more than 1.1 million lives compared to Cigna's 71,000 lives, which places it below many regional carriers (HealthLeaders-InterStudy estimates). Individual and small-group lives have been strong segments for Anthem, while Cigna has made only a few forays into that space.

However, the $54.2 billion merger could make the combined company a player in places where Anthem has been forbidden from selling plans. In 2016, it won't be much, but the deal opens up some potentially huge growth corridors in states and regions where Anthem cannot sell under its own brand.

Anthem and Cigna only overlap in three exchange markets: Colorado, Georgia and Missouri. Already a leading insurer in Missouri, Blue Cross and Blue Shield licensing agreements prevent Anthem from selling in the state's largest market, Kansas City, where an independent Blue plan dominates. If Anthem retains Cigna as a brand that could be a game-changer in Kansas City. Neither Anthem nor Cigna has broken into the Colorado exchange. But the merged company could possess new vigor in one of the nation's most competitive commercial markets.

The five Cigna markets without any overlap pose the greater growth prospects. Anthem's biggest opportunity to reshape exchange markets lies in Florida and Texas, which are Cigna's top states for exchange enrollment. Both have competitive exchange markets where the state's nonprofit Blue plans dominate. With a Cigna a big player in both states and an exchange carrier, Anthem could access Miami, Houston, San Antonio and Dallas-Fort Worth.

Cigna has not done as well in Arizona, Maryland and Tennessee, but the merger could provide a needed boost.
However, questions remain about how the merger could change activity for both companies in the exchange. After all, Anthem was in the Texas market not too long ago under the UniCare brand, which Anthem it folded due to an inability to grow market share.

In the interest of full disclosure: I?m a skeptic that Anthem and Cigna can complete a merger on this scale with so many intricacies and complications. Of the three mergers recently announced (Centene-Health Net, Aetna-Humana being the others) Anthem-Cigna easily has the highest hurdles to leap.

Should the merger come to fruition, look for the new company to be aggressive in non-Anthem markets, especially those with high exchange enrollment. Cigna might be absorbed by Anthem, but as a brand in the health exchanges, it could be a major growth engine.

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