Health insurers are facing renewed fire from President Barack Obama and Democrats, but are still mostly on board with the president's effort to overhaul the U.S. health-care system.
That's because the industry conceded months ago to key demands that Mr. Obama has just begun promoting. And insurers still have much to gain from an overhaul because they could get millions of new customers.
In a town-hall meeting Wednesday in Raleigh, N.C., Mr. Obama took aim at insurers as a way of selling his health plan. "The truth is, we have a system today that works well for the insurance industry, but it doesn't always work well for you," the president said.
He said he wants to forbid insurers from denying coverage to people because they have a pre-existing illness, cap consumers' out-of-pocket medical costs and provide preventive care at no additional cost.
In fact, insurers have already agreed to stop denying coverage to the sick and charging people higher premiums because of their gender or health status, as long as lawmakers pass a requirement that most Americans have to carry health insurance. Such a requirement is part of most of the bills making their way through Congress.
"We really have enormous agreement about the insurance reforms," said Ron Williams, chief executive of Aetna Inc., one of the nation's largest carriers. Mr. Williams has met with Mr. Obama privately or in small groups six times, the company said, and the CEO has personally pushed for such changes as far back as 2005.
"Consumers don't necessarily understand how the industry has changed and the commitments we've made to eliminate some of the challenges," Mr. Williams said.
Insurance-industry executives are privately complaining that the administration's rhetoric is eroding the consensus they have spent months trying to build with lawmakers, one industry official said. Another point of frustration is that the Senate is moving toward taxing insurers on particularly generous health plans to help pay for expanding coverage of the uninsured.
If health legislation succeeds, the industry would likely get a fresh batch of new customers. In particular, many young and healthy people who currently forgo coverage would be forced to sign up and pay premiums that would offset the cost of insuring older Americans.
Insurers have focused their opposition on some Democrats' push to create a new public health-insurance plan -- an entity they fear will drive private insurers out of business. House versions of the legislation include a public plan, but the Senate Finance Committee is expected to opt for nonprofit cooperatives that would pose less of a threat to private insurers.
Karen Ignagni, president of America's Health Insurance Plans, the industry's main lobby, said the battle over the public plan has been "obscuring the consensus about insurance-market reforms." The group recently began airing national television advertisements trumpeting its support for not rejecting people based on pre-existing health conditions.
Still, insurers are pushing back against several proposals that lawmakers see as favorable to consumers. One proposal would prevent insurers from charging older Americans more than twice the rates charged to younger people. Insurers want to be able to charge older people as much as five times more.
Some insurers also are calling for a higher cap on consumers' out-of-pocket costs and are warning that waiving charges for preventive care will simply lead to higher costs elsewhere. "If you put too low a cap on out-of-pocket expenses, that could drive up the premium," said Alissa Fox, a senior vice president at the BlueCross BlueShield Association, which represents 39 independent insurers nationwide.
Meanwhile, insurers continue to wage an aggressive campaign against Democrats' proposals to create a public health-insurance plan. America's Health Insurance Plans has stationed employees in 30 states who are tracking where local lawmakers hold town-hall meetings.
Big insurer WellPoint Inc. has set up an online network where it makes the case against the public health insurance plan and urges consumers to contact their elected officials.