A spokesman for Aetna said the companies are prepared to discuss remedies with Missouri regulators, noting that the order will not impact the pending federal regulatory process at the Department of Justice.
"This order does not impede the DOJ approval process. We are disappointed with the Missouri order but expect to have a constructive dialogue with the state to address their concerns," said T.J. Crawford, Aetna's head of media relations.
Last month, Aetna and Humana said they had obtained 15 of 20 necessary state approvals, and the companies' executives say they still expect the deal to close in the second half of the year.
Elevation LLC analyst Ira Gorsky says while Missouri's order presents a hurdle for the insurers, it amounts to conditional approval of the deal. He doesn't see a problem for the companies to negotiate the required state concessions.
"It's the first state approval to require conditions," said Gorsky. "I think this is normal in the course of the process, and anyone that has been following this closely should have expected divestitures."
Gorsky notes Missouri is one of three states where Aetna and Humana would have a large presence in the Medicare Advantage market as a combined company, along with Texas and Florida. Florida insurance officials approved the merger last February without any concessions; Texas regulators are still reviewing the deal.
Anti-trust attorney David Balto hailed Missouri's decision. Balto represents hospital, union and consumer groups opposed to both Aetna's acquisition of Humana and Anthem's $54 billion dollar deal to buy Cigna, concerned that the mergers between four of the nation's largest insurers will result in less competition and higher prices.
"Missouri's decision provides a concrete roadmap about how consumers will lose if these mergers are approved," Balto said in a statement.