Health Care

When the debate over national health-care reform begins in earnest, the health insurance industry's biggest trade association may be much less of a player than expected. In recent weeks, the Health Insurance Association of America has lost two of its biggest members, Aetna Life & Casualty Co. and Metropolitan Life Insurance Co. With membership renewals coming up, Travelers Corp. is also considering a pullout, and Prudential Insurance Co. may follow. And the last members of the "Gang of Five" big health insurers, CIGNA Corp., quit the group last year.

The problem is a deep split between the biggest companies and smaller insurers. The Gang of Five see managed-care networks as the wave of the future and would like any reform legislation written to encourage their use. The smaller companies think that they don't have the wherewithal to set up broad networks and fear they would be frozen out of the sort of national system that their rivals envision.

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