The following opinion article first appeared in the Detroit News January 23, 2008.

By Aetna President Mark Bertolini

With 1 million residents uninsured, Michigan understandably is anxious for real health care reform. But experience has taught us that hasty actions in other states have had unforeseen and troubling consequences for health care consumers.

Take Kentucky. In 1994, the Kentucky Legislature passed sweeping measures that resulted in a risk-adjustment process among insurers that favored Blue Cross Blue Shield. The legislation mandated a new statewide health purchasing alliance, which also served as the "insurer of last resort" for the uninsured. By December 1996, 45 insurers withdrew from the state's individual insurance market, and the state's uninsured swelled to 15.6 percent of the population.

In 2004, lawmakers adopted legislation aimed at undoing the damage. The state continues to explore new ways to resuscitate its individual market.

Michigan stands at a crossroads similar to that of Kentucky in 1993. The House passed -- in 12 days -- a package of health insurance bills (sought by Blue Cross Blue Shield of Michigan) that are fraught with problems. The bills would do nothing to address the uninsured, promote health care quality or reduce costs. Curiously, they would help Blue Cross shed its social mission as an insurer of last resort to make coverage available at a reasonable price to all who request coverage and virtually become a commercial insurer -- while continuing to be exempt from state taxes.

While commercial insurers paid $249.5 million in state taxes in 2006, Blue Cross, the state's largest health benefits carrier in 2006, enjoyed an exemption from at least $100 million in state and local taxes. Blue Cross estimates its losses in the true individual market were $6.5 million in 2006, quite a handsome tradeoff in relation to the benefits of such generous state and local tax exemptions.

The House bills would transfer responsibility for covering many of the uninsured to a new high-risk pool, to be funded largely by Blue Cross's commercial competitors, such as Aetna. They also would substantially limit governmental oversight of Blue Cross.

The result would be to saddle competitors with a new layer of taxation and further decrease competition and access to affordable insurance.

We are encouraged that the state Senate is taking a careful look at the proposals and gathering valuable input. The Senate should look at reinvigorating Blue Cross' social mission by spending down its reserves -- money that Blue Cross asserts belongs to the people of Michigan -- to benefit those who are unable to afford coverage. Eliminating pre-existing condition exclusions from Blue Cross' coverage of individuals also should be considered.

Most of all, the Legislature should look for ways to spark increased competition in the individual market to help generate the savings needed to ensure improved access to affordable health care coverage.