Aetna is the largest single processor of Medicare claims, but, McLane said, "I could not recommend that Aetna just proceed on being a processor, because shareholders would not put capital into the company if that's what you did."
Under its contract with the federal government, McLane said, Aetna is paid what it costs to process Medicare claims but makes no profit. Aetna has stuck with the business, though, because it has learned much about handling claims electronically, without paper.
Insurers also are worried about the various "play-or-pay" reforms, which aim at getting more employers to insure workers. Those proposals would require employers to buy health insurance for their workers or pay for them to be covered by a government-created pool.
Employers' payments for the pool coverage would be based on some percentage of their payroll.
Supporters of the play-or-pay approach see it as a way of reaching the majority of the uninsured, who are low- and middle-income wage workers or are in families headed by workers. But insurers say it is nothing but a back door to a single-payer system. The plans, they say, would hurt small businesses.
That is because the payments for pool coverage would have to be set low enough so they would not overburden small businesses. That might make it more attractive for employers to choose the pool rather than pay ever-rising premiums, so the pool would grow and private insurance would shrink, insurance executives say.
Play-or-pay reforms could also lead to burdensome regulation of private health insurance, Libassi of Travelers said.
"When people are required to buy our products," Libassi said, "it brings with it considerable government regulation as to what the product is, how it will be designed, how much it will cost (us) and what we can charge for it."
Much more to the industry's liking are "market reforms," which would deal the softest blow to insurers.
The national reforms proposed by the Health Insurance Assn. of America aim to encourage more small businesses and self-employed people to buy insurance.
The plan would:
* Strip state-mandated benefits from health insurance policies to make them cheaper.
* Create a pool of insurers and self-insured employers to absorb the losses from insuring high-risk employers who previously could not buy coverage.
* Encourage states to establish pools to insure high-risk individuals.
* Provide a 100% tax deduction on premiums for the self-employed.
* Expand income limits for Medicaid eligibility to federal poverty level in all states.
Insurers also have been pushing state-level reforms that would guarantee that small businesses could buy insurance regardless of workers' health problems, and restrict the rate increases that carriers can impose from year to year.
In addition, many insurers support changes in malpractice liability laws to discourage doctors from performing more tests and procedures than necessary in order to protect themselves from lawsuits.
Insurers' proposed reforms, which rely heavily on getting more small businesses to provide insurance, do not assure universal health care, proponents of a single-payer system say.
