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Kaiser Permanente has agreed to acquire Geisinger and create a new national not-for-profit system that encompasses health insurance, hospitals, and medical groups.

The mega-deal marks the biggest proposed health care acquisition in recent memory, potentially bringing together two systems that operate on different sides of the country but have taken similar approaches to managing patients’ health care in a closed delivery system. It also will be the biggest test yet to see if state and federal antitrust enforcers buy the argument that cross-market hospital and insurance deals won’t hurt consumers and won’t thwart competition.

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The new system would have more than $100 billion of annual revenue, a vast majority of which comes from Kaiser and its expansive health insurance operation that covers roughly 13 million people across the country, mostly on the West Coast. Kaiser, which tallied more than $95 billion of revenue last year, also operates 39 hospitals and employs nearly 24,000 physicians.

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