If no health care overhaul passes Congress, health insurers may be in for a windfall — and one far larger that most Americans probably realize.

According to a study by a pro-health reform group published Thursday, the nation’s largest five health insurance companies posted a 56 percent gain in 2009 profits over 2008. The insurers including Wellpoint, UnitedHealth, Cigna, Aetna and Humana, which cover the majority of Americans with insurance.

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The insurers’ hefty profit gains came even as 2.7 million more Americans lost their insurance coverage due to the declining economy.

A lobbyist for American’s Health Insurance Plans, the trade group that represents insurers in Washington, D.C., attributed the gain in 2009 profits to a poor performance in 2008. In 2008, insurers were forced to write down their stock holdings because of the US market’s declines. Insurance companies keep a great deal of money in the markets, earning interest from the time between premiums are paid and the time when health providers are paid.

“It is disingenuous to look at the profits at one company today compared to where it was in the depth of a recession,” Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, told the Cleveland Plain Dealer.

The insurer profit study was prepared by the liberal-leaning group Healthcare for America Now, an organization bankrolled by labor unions, which typically take strong positions in favor of Democratic policies, while historically being highly critical of Republicans.

“Insurers will – perversely – try and blame the economy for their record-breaking fortunes, saying employers have been shedding jobs and therefor dropping insurance coverage, leading to a decrease in customers,” a press release for Health Care for America Now said. “And they’re certainly right in the sense that less jobs equals less employer-based health coverage, but that obscures the fact that employers have been steadily dropping health coverage for more employees for 15 years – even during good times – because the insurance industry’s prices keep skyrocketing much faster than inflation.”

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“None of the excuses can explain away the basic reality that insurers make more money when they insure less people. They can pay their CEOs more (“administrative costs” rose this year) when they can charge the healthy exorbitant prices and drop or deny these loyal customers when they become sick and therefore expensive,” the release added.

Notably, the study also found that insurers spent less money on medical care as a percentage of their premiums from customers. Salaries, administrative expenses and profits made up more of the insurer’s expenses in 2009.

Wellpoints Anthem Blue Cross California created a stir earlier this week by announcing that they will raise premiums on individuals by 39 percent in 2010. The increase was so high it drew a rebuke from the Obama Administration. Wellpoint defended the increase, saying the decline in customers had increased the percentage of sick patients under their care, thus warranting a higher charge to consumers. Wellpoint also pointed out that their California division actually lost money in 2009.

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Yet, the company posted a profit of $4.7 billion for the year. That put them at a higher profit margin (7.3 percent) than any of the other top five American insurers.

Wellpoint’s CEO also recently said they are considering paying a dividend to their investors — a sign of their profitability — which might further rankle insurance company critics.

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Insurance companies typically average a profit margin closer to four percent, with about 80-85 percent of premiums spent on reimbursing patients’ medical expenses. The remainer goes to administrative costs, salaries and marketing. Under a bill under consideration in the Senate, medical “loss benefit ratios” would be set at 80-85 percent, meaning insurers would face little pressure to trim administrative costs relative to medical care.

Other highly profitable insurers in 2009 included Humana, which saw a profit yield of 7.1 percent.

Despite record 2009 profits, insurers are under increasing pressure to deliver gains for investors, as the pool of insured Americans continues to fall. Insurance companies that make much of their money from businesses’ healthcare plans have seen declining rolls amid an economy roiled by a nearly 10 percent unemployment rate.

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Some analysts have also said that the failure of the health insurance reform package could damage insurance companies in the long run, because subsidies from the federal government would have likely insured 30 million new customers.

Health Care for America Now’s study also highlighted the following statistics:

* The five largest insurance firms firms made $12.2 billion, an increase of $4.4 billion, or 56 percent, from 2008.

* Four out of the five companies saw earnings increases, with CIGNA’s profits jumping 346 percent.

* The companies provided private insurance coverage to 2.7 million fewer people than the year before.

* Four out of the five companies insured fewer people through private coverage. UnitedHealth alone insured 1.7 million fewer people through employer-based or individual coverage.

* All but one of the five companies increased the number of people they covered through public insurance programs (Medicaid, CHIP and Medicare). UnitedHealth added 680,000 people in public plans.

* The proportion of premium dollars spent on health care expenses went down for three of the five firms, with higher proportions going to administrative expenses and profits.

Correction: The first version of this article said insurers posted a 57 percent gain, instead of 56 percent. It has been corrected in this edition.