An announced acquisition of Willis Towers Watson PLC (WTW) by fellow insurance broker Aon PLC fell apart after the Dept. of Justice (DOJ) sued to block the transaction due to antitrust concerns. Experts say that the collapse of the deal — which would have created the world’s largest insurance broker — is proof of the Biden administration’s commitment to undoing consolidation, and they say WTW will likely reimagine its business, perhaps by acquiring smaller players.

“Despite regulatory momentum around the world, including the recent approval of our combination by the European Commission, we reached an impasse with the U.S. Department of Justice,” said Aon CEO Greg Case in a July 26 press release. “The DOJ position overlooks that our complementary businesses operate across broad, competitive areas of the economy. We are confident that the combination would have accelerated our shared ability to innovate on behalf of clients, but the inability to secure an expedited resolution of the litigation brought us to this point.”

Seven states have moved this year to cap out-of-pocket expenses for diabetic patients’ insulin, a trend that should help a small group of people who generally are uninsured or have high-deductible plans and have struggled to afford their medication. But it is unlikely to expand beyond insulin or impact health plans’ bottom lines, industry observers say.

The states that have enacted insulin legislation this year — Colorado, Maine, New Mexico, New York, Utah, Washington and West Virginia — generally cap out-of-pocket costs for some or most patients at $100 per month. Those new state laws join insulin copay legislation already on the books in eight other states, including Alabama, Delaware, Kentucky, New Hampshire, Oklahoma, Oregon, Rhode Island, Texas and Virginia, according to a report from the National Conference of State Legislatures (NCSL).

Jeff Myers, senior vice president of market access and reimbursement strategies at Catalyst Healthcare Consulting, Inc., says he doesn’t expect insulin copay caps to cost health plans a significant amount of money. However, the funds have to come from somewhere, because the states by themselves can’t force the price of insulin down.

Although health insurance companies in the past decade have significantly grown and diversified — thus strengthening their businesses — their credit ratings haven’t benefitted very much, at least according to one prominent rating firm. The reason, according to Dean Ungar of Moody’s Investors Service, is that insurers have taken on more debt in order to finance their acquisition sprees, and it’s not yet certain whether those moves will pay off.

Ultimately, “we think if the leverage can kind of stabilize and maybe come down a little bit, you [will] see a stronger business profile in terms of capabilities, scale and scope,” Ungar tells AIS Health, a division of MMIT.

In a report published earlier this month, Ungar and other Moody’s analysts argue that the health insurance industry has come a long way since 2010. The shift from fee-for-service to a value-based care model is ongoing, insurers are paying more attention to social determinants of health, and the changing business environment “has driven a significant amount of consolidation and vertical integration among our rated companies,” according to the report.

Centene Corp. and Humana Inc. both reported slightly better-than-expected second quarter 2021 results, which Wall Street met with cautious optimism. While executives from both health insurers preached caution due to the Delta variant-driven resurgence of the COVID-19 pandemic, analysts projected both firms to be profitable for the rest of the year.

Centene generated $1.25 in adjusted earnings per share, which beat Wall Street’s consensus EPS projection of $1.21. Meanwhile, Humana reported adjusted EPS of $6.89, exceeding Wall Street’s projected EPS of $6.83.