The writing for this has been on the wall for a long time. Seems like every year some small insurance company is swallowed by UPMC or Highmark. Then the ones they can't buy go under because they can't compete with the rates offered by the other two.

You watch, in another 10 years they'll carve out small kingdoms of exclusive insurance in the same way the ISP's did with their service areas. "Oh you want to go to this hospital? Too bad, its in Blue Team's network, and you're Red. Drive 45-60 minutes to the nearest Blue Team hospital."