WASHINGTON • The health insurance industry offered Tuesday for the first time to curb its controversial practice of charging higher premiums to people with a history of medical problems.

The offer from America’s Health Insurance Plans and the Blue Cross and Blue Shield Association is a potentially significant shift in the debate over reforming the nation’s health care system to rein in costs and cover an estimated 48 million uninsured people. It was contained in a letter to key senators.

In the letter, the two insurance industry groups said their members are willing to “phase out the practice of varying premiums based on health status in the individual market” if all Americans are required to get coverage.

“The offer here is to transition away from risk rating, which is one of the things that makes life hell for real people,” said health economist Len Nichols of the New America Foundation public policy center.

Insurers are trying to head off the creation of a government insurance plan that would compete with them, something many Democrats are pressing for. To try to win political support, the industry has made a number of concessions.

Insurance companies now charge very high premiums to people who are trying to buy coverage as individuals and have a history of medical problems, such as diabetes or skin cancer. About 7 percent of Americans buy their coverage as individuals, while more than 60 percent have job-based insurance.

The companies left themselves several outs, however. The letter said they would still charge different premiums based on such factors as age, place of residence, family size and benefits package. And importantly, the industry did not extend to small businesses their offer to stop charging the sick higher premiums. Small employers who offer coverage can see their premiums zoom up from one year to the next, even if just one worker gets seriously ill. Karen Ignagni, president of America’s Health Insurance Plans, the leading trade group, said the industry is working on separate proposals for that problem.

DETAILS

The proposal by the health insurance industry offers to phase out higher premiums for people with a history of medical problems, but the plan applies only to those people who buy coverage as individuals.

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