Health and Human Services Secretary Kathleen Sebelius this morning faced off with Karen Ignagni, president of America's Health Insurance Plans, at the group's Washington meeting. Although the two were cordial to each other, the tone was very serious.

Sebelius claimed she wasn't there to "vilify or blame insurance companies for all of the nation's health care problems," but her criticisms of the industry were severe. She restated her request that insurers make transparent information about their premium increases and profits. And she hammered insurers for "spending tens of millions of dollars to help kill health reform." If the industry continued to oppose reform, she said, failure would mean more uninsured people and higher prices. "It's not too late to work on this issue together."

Ignagni claimed her group has always backed reform, but that everyone must be brought into the system to make insurance affordable. Costs are the issue, she said, noting that premium increases are a result of underlying cost issues throughout all sectors of the health care system, and not just due to carrier profits. And she called for an end to the "relentless attack on the men and women of our industry."

The current reform legislation, Ignagni said, "would make health care more expensive, not more affordable." She said the group would be working with the National Association of Insurance Commissioners today on a template to help insurers offer transparency to customers and would get back to Sebelius shortly with proposals to improve reform legislation.

Ignagni said those recommendations would address several cost-related issues, including making sure that reform bills have more than "de minimus" penalties for failure to purchase policies, which she said would lead to an expensive market of mostly sick people. She said the industry also has ideas about rating bands and said that she wanted to discourage "Medicare cuts."

Most academics, Ignagni said, are "realizing that the consolidation of the market is making it difficult to negotiate rates." She also wants to see proposals for pilot projects expanded to involve everyone. She added: "We need a failsafe certification that if costs go up more than expected [in any part of the health care industry], something is done."

AHIP had invited Sebelius several months ago to address its members at the conference but she had declined, citing a schedule conflict. On Tuesday, Sebelius wrote to Ignagni that she could speak at 10:30 this morning.

AHIP spokesman Robert Zirkelbach said the group was caught totally off guard by the request, but was delighted. An official from the Centers for Disease Control and Prevention was scheduled in that time slot, as were two others who were pushed back.