Three of America's largest health insurance companies have decided not to participate in California's Obamacare exchange. Why? Because "no comment". The companies that are participating are already bigger players in California's insurance market, so they pretty much had to play ball or go out of business.

Some prominent health insurers, including industry giant UnitedHealth Group Inc., are not participating in California's new state-run health insurance market, possibly limiting the number of choices for millions of consumers.

UnitedHealth, the nation's largest private insurer, Aetna Inc. and Cigna Corp. are sitting out the first year of Covered California, the state's insurance exchange and a key testing ground nationally for a massive coverage expansion under the federal healthcare law.

Meanwhile, the biggest insurers in the state -- Kaiser Permanente, Anthem Blue Cross and Blue Shield of California -- are all expected to participate in the state-run market for individual health coverage.

What it means: everyone who had a choice decided to opt-out. Is this a trend?

[Glenn Melnick, a health policy professor at USC,] said UnitedHealth, Aetna and Cigna may be making a mistake by sitting on the sidelines given California's size and importance in the healthcare overhaul nationwide. "California is going to be a trendsetter," he said.

Melnick is probably right that California is setting a trend, but it may not be in the direction he's implying.

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