(Bloomberg) — America's biggest health insurers are about to get even bigger, driven into a wave of consolidation by the Patient Protection and Affordable Care Act new regulations and markets.

The disclosure of Anthem Inc. disclosure Saturday that it's offered about $47 billion for Cigna Corp. is the first public confirmation the deal-making is in full swing. Cigna rejected the offer on Sunday, despite Anthem's attempt to pressure Cigna's board by taking the offer public. Anthem, Aetna Inc. and UnitedHealth Group Inc. all are poised to emerge as buyers or sellers when the dust settles.

Driving the consolidation is PPACA, the 2010 health law that put tougher rules on the industry, demanding more covered services, better care and a ceiling on profits. It funded coverage for the uninsured, and companies are racing to capture the more than 20 million customers who will buy coverage through the PPACA markets, or Obamacare public exchange system.

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