They're still not performing as badly as major cable companies, but health insurers are receiving mediocre marks at best from American consumers. 

After rising to a score of 75 out of 100 in 2009, health insurers' support from their customers has slipped consistently to a decade-low score of 69, according to the American Consumer Satisfaction Index. 

The three top performing insurers were Humana and the nonprofit Kaiser Permanente, both of which scored 71. Closely behind, at 70, was Blue Cross and Blue Shield. Anthem scored 69, while Aetna got a 68, UnitedHealth got a 66 and Cigna, at the very bottom, scored 60. 

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