NATIONAL HARBOR, MD. — Something has to change, or rising health costs will cripple businesses and the federal government.

Vice President Joseph Biden delivered that message here today at the fall meeting of the National Association of Insurance Commissioners, Kansas City, Mo.

Biden reminded insurance regulators in the audience that the cost of health insurance premiums has gone up 90% to 150% in the last decade.

The gaps between premium increases and wages are growing, Biden said. In Florida, he said, health coverage rates have increased 121%, while wages have risen 43%. In Michigan, the state with the smallest gap, there is still a 37% gap between premium increases and wage increases, Biden said. Individual reform ideas can be debated, Biden said, but if nothing is done, in 30 years, 1 in every 3 dollars will be spent on health care.

“Spending by federal government on Medicare and Medicaid alone will be 15% of GDP by 2040,” Biden said. “It’s now around 5%.”

The high cost of the health care system is already hurting U.S. businesses’ ability to compete internationally, Biden said.

“This is simply an unsustainable position,” he said. “I want insurance companies to make money. But I also want them held accountable.”

Biden said he would like to see health insurers abide by the following “basic ground rules”:

- No preexisting condition exclusions.

- No exorbitant out of pocket expenses, deductibles or co-pays.

- No cost sharing for preventive care.

- No dropping of coverage for the seriously ill.

- No more lifetime caps on coverage.

Biden said these ground rules would not affect companies’ ability to compete, because the same rules would apply to everyone. Under the current system, he said, companies that “do the right thing” would be at a competitive disadvantage.

Biden praised insurance commissioners for understanding the need for reform, for speaking out in favor of it, and for dealing first hand with consumer complaints about the current system.

Responding to Biden’s speech, Connecticut Insurance Commissioner Tom Sullivan said he agrees that the U.S. health care system is on an unsustainable path, but he expressed dismay at the lack of details provided on how to address rising costs in health care.

Biden “talked about bending the cost curve, but I didn’t hear any details on how to bend the cost curve, and I think any elements of reform need to address that with some level of precision and acuity,” Sullivan said.

Sullivan said he agrees with Biden that the cost of the Medicare and Medicaid programs needs to be addressed. “I think we need to deal with the public plan today that’s broken with respect to how it’s financed,” he said.

Financing any reform proposals and dealing with the rising costs of health care are the main concerns with any reform efforts, Sullivan said.

The NAIC as a body has released its own reform principles. Those principles include:

- Universal coverage.

- A requirement that everyone to buy health insurance just as many states require all drivers to buy auto insurance.

- Equal treatment, such as no denials for preexisting conditions.

- A ban on the use of health status, gender or occupation when setting premiums.

- Removal of caps on annual or lifetime benefits under a policy.

NAIC President Roger Sevigny, the New Hampshire insurance commissioner, acknowledged that individual commissioners may support other specific reform ideas.

“We have not taken a position on any piece of legislation as a body,” Sevigny said. “We are very much sticking to the principles that we’ve made public.”

Sevigny and other state commissioners said they expect to have a regulatory role under any reform plans, and they said the magnitude of any diminishment of their regulatory role under, for example, a public option, would depend on how the proposed program was structured.

NAIC President-elect Jane Cline, the West Virginia insurance commissioner, said commissioners see themselves as being technical advisors on the effects of the specific provisions of a given bill.

The commissioners expressed confidence that some form of health care reform will be achieved.