But some vulnerable patients are probably going to feel a little cheated. Consider this coverage wrinkle:

Suppose your cancer is in remission. You had to quit your job while you were having chemotherapy, and your employer coverage ran out. You cant find a private insurer wholl take you, but youre lucky to live in a state that has its own high-risk pool. Still, you have to struggle to pay the premiums, well above standard insurance because sicker people are in the group. Yet as the federal program is designed, you wouldnt be able to switch over and take advantage of significant savings.

The reason: You have to be uninsured to qualify for the new plan.

“Its awkward,” said John Rother, senior strategist for AARP, which supported the overhaul. “None of us would want to see the program lock people in to the more expensive existing coverage, but to switch over all those people would have definitely boosted the cost, and Congress was looking for ways to minimize it.”

That means some 200,000 patients now enrolled in more than 30 state high-risk insurance pools will be stuck paying higher premiums. Many are on tight budgets, drawing down their savings and borrowing from family members.

Premiums in the new federal pool are expected to be 10 percent to 50 percent lower than current state rates, said Richard Popper, who directs Marylands program. Co-payments and deductibles are also expected to be considerably lower. But the only way current beneficiaries could get the federal coverage would be to drop out of their state pool and go uninsured for six months.

“That would be a very risky thing to do,” said Stephen Finan, policy director for the American Cancer Society Cancer Action Network. “Can you afford to go without coverage for six months in the hopes of getting a better price? Its a big gamble.”

Health and Human Services Secretary Kathleen Sebelius calls the federal risk pool a first step toward ending insurance discrimination against people with health problems. But HHS officials say Congress wrote the rules and theres nothing they can do to open up the program to people now in state pools. The federal pool is designed for the uninsured.

The program will be temporary, a bridge to 2014, when denial of coverage for medical reasons will be against the law, and new insurance markets will offer taxpayer subsidized coverage for millions. Number crunchers at Medicare estimate that 375,000 people will sign up this year.

Sebelius says she expects the plan will operate alongside state risk pools where such programs exist - making premium comparisons inevitable. Shes also planning a national program to serve people in states that have no risk pools, or opt not to participate.

Georgia insurance commissioner John Oxendine announced this week that his state would not. Oxendine, a Republican running for governor, questioned the constitutionality of the federal overhaul law, and said he thinks joining the new risk pool could end up costing state taxpayers money.

A recent report by Medicare economists warns that the program could go through $4 billion in its first year, and run out of money as early as 2011.

“These are some of the sickest people in the country, and therefore their costs would be dramatically higher - yet the law requires that they be subsidized to standard rates,” said Robert Laszewski, a health care industry consultant. “I think theyve given (Sebelius) an impossible task.”

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Under the new law, insurance companies still would be able to refuse new coverage to children because of a pre-existing medical problem, said Karen Lightfoot, spokeswoman for the House Energy and Commerce Committee, one of the main congressional panels that wrote the bill Obama signed into law Tuesday.

However, if a child is accepted for coverage, or is already covered, the insurer cannot exclude payment for treating a particular illness, as sometimes happens now. For example, if a child has asthma, the insurance company cannot write a policy that excludes that condition from coverage. The new safeguard will be in place later this year.

Full protection for children would not come until 2014, said Kate Cyrul, a spokeswoman for the Senate Health, Education, Labor and Pensions Committee, another panel that authored the legislation. Thats the same year when insurance companies could no longer deny coverage to any person on account of health problems.

Obamas public statements have conveyed the impression that the new protections for kids were more sweeping and straightforward.

“This is a patients bill of rights on steroids,” the president said Friday at George Mason University in Virginia. “Starting this year, thousands of uninsured Americans with pre-existing conditions will be able to purchase health insurance, some for the very first time. Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.”

And Saturday, addressing House Democrats as they approached a make-or-break vote on the bill, Obama said, “This year … parents who are worried about getting coverage for their children with pre-existing conditions now are assured that insurance companies have to give them coverage - this year.”

Late Tuesday, the administration said Health and Human Services Secretary Kathleen Sebelius would try to resolve the situation by issuing new regulations. The Obama administration interprets the law to mean that kids cant be denied coverage, as the president has said repeatedly.

“To ensure that there is no ambiguity on this point, the secretary of HHS is preparing to issue regulations next month making it clear that the term pre-existing exclusion applies to both a childs access to a plan and his or her benefits once he or she is in the plan for all plans newly sold in this country six months from today,” HHS spokesman Nick Papas said.

The coverage problem could mainly affect parents who purchase their own coverage for the family, as many self-employed people have to do. Families covered through employer plans typically do not have to worry about being denied coverage because of pre-existing conditions.

Parents whose kids are turned down by an insurer would still have a fallback under the law, even without Sebelius fix. They could seek coverage through state high-risk insurance pools slated for a major infusion of federal funds.

The high-risk pools are intended to serve as a backstop until 2014, when insurers no longer would be able to deny coverage to those in frail health. That same year, new insurance markets would open for business, and the government would begin to provide tax credits to help millions of Americans pay premiums.

“Were taking a closer look at it to see what exactly the requirement will be,” said Robert Zirkelbach, spokesman for Americas Health Insurance Plans, the main industry lobby.

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Foreign life insurance “is again one of the crown jewels,” he said at a conference. The business “simply could not be replicated” by competitors, he said. The following timeline details the building and dismantling of the operation.

1919: Cornelius Vander Starr founds American Asiatic Underwriters in Shanghai.

1921: Starr establishes Asia Life Insurance Co., which will later become American Life Insurance Co., known as Alico.

1931: Starr founds International Assurance Co. in Shanghai. The company later changes its name to American International Assurance Co., also known as AIA.

1968: AIG is formed to hold companies founded by Starr.

1992: AIA is the first foreign-owned life- and non-life insurance business to receive a license in China, according to the companys Web site.

May 5, 2006: AIA wins approval to sell group life in China.

Dec. 5, 2007: AIG, at an event originally planned to tout non- U.S. life units, changes the agenda under pressure from investors to discuss mortgage bets. Then-CEO Martin Sullivan says writedowns tied to home loans are “manageable.”

April 9, 2008: AIG projects operating profit from life insurance and retirement services outside the U.S. to climb about 88 percent by 2012 to $12 billion. “Im extremely pleased that were getting back to discussing core businesses,” Sullivan says at an investor meeting, which was postponed from December.

Sept. 16, 2008: AIG accepts an $85 billion loan from the Federal Reserve and agrees to hand over majority control to the U.S. after bets on subprime mortgages drained cash from the firm.

Feb. 24, 2009: AIG is said to get bids from MetLife and Axa SA for Alico, which has operations in Japan and Europe. MetLife offered about $11.2 billion, say people familiar with the matter.

Feb. 27, 2009: Manulife Financial Corp. and Prudential Plc may offer cash and shares for AIA, according to people with knowledge of the matter. AIG told potential bidders that it is willing to sell as much as 100 percent of AIA, the people say.

March 2, 2009: Alico and AIA will be transferred into Fed vehicles to lower AIGs debt, the company says. The deal helps AIG refuse offers it considers inadequate.

March 18, 2009: Liddy tells Congress that “the continued deterioration of world markets and the inability of buyers to access capital have impeded our ability to secure sufficient value for AIG assets.”

Dec. 1, 2009: AIG cuts Fed debt by $25 billion after transferring AIA and Alico to Fed vehicles in anticipation of initial public offerings or third-party sales, AIG says.

Feb. 2, 2010: MetLife says it is in talks to buy Alico.

March 1, 2010: Prudential, Britains biggest insurer, agrees to pay $25 billion in cash and $10.5 billion in securities for AIA.

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“This is a move to increase that exposure without disrupting the pricing,” said Craig Fehr of Edward Jones & Co., who has a “hold” rating on Omaha, Nebraska-based Berkshires stock. “Its likely a reflection of the fact there arent an abundance of opportunities to write new business.”

Buffetts biggest takeovers in the last decade have boosted Berkshires energy and freight businesses, reducing his companys reliance on insurance. Two years ago, he warned of an industry slump after underwriting results slipped from a record. “That party is over,” Buffett wrote in his 2007 letter to investors, and Berkshires underwriting profits have since slipped about 60 percent.

The 2009 letter is scheduled to be released tomorrow with fourth-quarter results. Meyer Shields, an analyst with Stifel Nicolaus & Co., expects Berkshire to post net income of $1,354 a share, compared with $76 in the year-earlier period, according to Bloomberg data. Berkshire stock has risen 23 percent since the end of 2008 as Buffett purchased railroad Burlington Northern Santa Fe for about $27 billion in his largest takeover.

Appetite for Risk

Berkshire, which sells protection through General Re and Berkshire Hathaway Reinsurance Group, scaled back on the coverage of large risks to conserve capital in the first half of last year. The company said in August it had recovered its appetite for new business, while adding it would wait to increase sales until prices improved.

The price for catastrophe reinsurance fell for the third time in four years when insurers renegotiated their annual contracts on Jan. 1, according to Guy Carpenter & Co., a unit of brokerage Marsh & McLennan Cos. Prices typically fall when the economy declines, as companies have less to insure. Rates also slide when an increase in industry capital gives carriers the capacity to sell more protection than the market needs.

Reinsurer capital rose in 2009 as stock and bond market rallies boosted investments and the quietest Atlantic storm season in more than a decade reduced claims costs. In 2008, catastrophes including Hurricanes Ike and Gustav cost property insurers $52.5 billion worldwide, according to a Swiss Re study.

Global Easing

“Weve seen a global easing of rates in the reinsurance market,” said Bryon Ehrhart, CEO of Aon Benfield Analytics, the reinsurance arm of Aon Corp., the worlds largest insurance broker. “Theres never been more capital in the reinsurance business than there is now.”

Selling another $1 billion of coverage through General Re in todays market would be “quite difficult” for Buffett, Ehrhart said. Still, he doubted that the amount Buffett put into Munich Re would be enough to influence prices if directed to Berkshires underwriters instead. Buffett didnt respond to a request for comment left with an assistant.

Buffetts Brand Loyalty

“For his large investments, he seems to be pretty loyal to that one company in that industry that he invests in,” said David Kass, a professor at the University of Marylands Robert H. Smith School of Business. “He has a large stake in Coca- Cola, of course, and doesnt as far as I know own any shares in PepsiCo. He has a large stake in American Express, and as far as I know has no investment in Visa or MasterCard.”

Buffetts diversification in reinsurance came as he narrowed his focus in railroads. Berkshire took stakes in three of the biggest U.S. haulers of freight before announcing last year the takeover of Burlington Northern and selling holdings in the other two. A buyout of one of Berkshires reinsurance rivals is less likely, analysts said, because clients would probably resist.

Valuing Diversity

“Theres no way they could do something strategic, given their own position,” said Tim Dawson, a Geneva-based analyst at Helvea SA. In a merger among top reinsurers, “the loss of business would be quite substantial. If youre an insurance company, you want to diversify your reinsurance coverage” to reduce the impact of one carrier being unable to meet its obligations after a major disaster, he said.

Berkshires profits from underwriting dropped to $665 million in the first nine months of 2009, compared with $1.72 billion two years earlier. Underwriting profit is the amount of premium left after a carrier pays claims and expenses. Insurers also record income by collecting dividends and bond coupons on investments they make with policyholder funds before the money is needed to pay claims.

Reinsurers, which served as “bankers of last resort” for insurers when capital was scarce in the 1990s, may again find greater demand amid European regulatory changes, according to Duncan Russell, Michael Huttner and other analysts at JPMorgan Chase & Co. The reform, known as Solvency II, will increase capital standards in coming years, pushing carriers to share more risks with reinsurers, the analysts said in a January report.

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“There are clear signs that AIG has pulled out of what could have been a death spiral,” said David Havens, managing director in credit trading at Nomura Securities International Inc. in New York. AIGs insurance results have been improving “after dropping off a cliff following the bailout,” he said.

Chief Executive Officer Robert Benmosche, 65, must increase insurance profits to repay loans included in AIGs government rescue. The CEO has said he would rebuild businesses damaged after AIGs derivatives unit, called an unregulated hedge fund by Federal Reserve Chairman Ben S. Bernanke, sapped the parent company of cash in the weeks leading to the bailout.

Fourth-Quarter Results

The insurer, which may report fourth-quarter 2009 results by next week, could show underwriting improving “more in line with the industry as opposed to worse than the industry average,” said Jennifer Marshall, an analyst at A.M. Best Co. in Oldwick, New Jersey, which rates insurers including AIG.

After scaling back operations at its plane-leasing unit, consumer lender and derivatives business and divesting its two largest non-U.S. life insurance divisions, AIG may remain the No. 1 U.S. commercial insurer. It is among top sellers of workers compensation, professional liability and property coverage, competing with Travelers Cos. and Warren BuffettsBerkshire Hathaway Inc.

AIG posted $7.1 billion in commercial property-casualty sales in the fourth quarter of 2008, the first full period after the bailout. That figure rose to $7.7 billion in the first quarter of 2009, $7.9 billion in the second and $8.1 billion in the third.

Life premiums and investment-product fees were $15.2 billion in the fourth quarter of 2008. That figure declined to $14.5 billion in the first quarter of 2009 after U.K. clients abandoned the firm, then fell to $13 billion in the second quarter before rising to $13.7 billion in the third.

“Things are stabilizing,” said Pennsylvania Insurance Commissioner Joel Ario, AIGs lead U.S. regulator for commercial insurance, citing the revenue figures as evidence.

2008 Stock Plunge

After the bailout, a 97 percent stock plunge in 2008 and criticism from lawmakers over retention bonuses paid to derivatives employees, there was “concern that most of AIGs largest customers would flee entirely,” said Robert Hartwig, president of Insurance Information Institute Inc., a trade organization in New York. “That didnt happen. Most of the larger insureds spread their business around, so AIG doesnt have as much of their account as they used to.”

Ship Afloat

“Theyve actually done a very good job of keeping the ship afloat,” James Tisch, CEO of Loews Corp., which owns about 90 percent of rival property-casualty insurer CNA Financial Corp., said in an interview. “Theyve done relatively well under a lot of stress and duress.”

Insurance buyers may find comfort in the governments 80 percent stake in the company and a $60 billion Federal Reserve credit line, said Shivan Subramaniam, CEO of FM Global, a Johnston, Rhode Island-based property-casualty insurer.

“People view the federal government as being a backstop,” said Subramaniam. AIG “continued to be competitive in the marketplace as theyve always been,” he said.

Under Benmosche, AIG will focus on selling coverage to corporate customers worldwide, the companys core business for most of its four decades under former CEO Maurice “Hank” Greenberg. Greenberg, who ran AIG until 2005, added life insurance, asset management, derivatives and a plane-leasing business to diversify revenue.

Selling Assets

Since the bailout, AIG has retreated from asset management for institutional clients and the U.S. auto insurance industry by striking deals to sell businesses for a total of about $12 billion. The company has said it expects to close its derivatives unit by year-end, while keeping $300 billion to $400 billion in trades AIG expects to be profitable.

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“The contingent commissions created inherent conflicts and tensions that led to improper practices that we were trying to eliminate,” Spitzer said yesterday in a phone interview. “It was part of a larger reform effort to protect consumers and ensure the integrity of the marketplace.” Spitzer, 50, declined to comment on the removal of restrictions.

Spitzer negotiated the ban five years ago to settle investigations into allegations of fraud and anticompetitive practices at the worlds three biggest brokers. As part of the settlements, New York-based Marsh & McLennan agreed to pay $850 million, Aon of Chicago pledged $190 million and Willis, $50 million. Removing the curbs may be a step back for consumers, said Joseph Belth of Indiana University.

The repeals “are a whittling away of reforms instituted by Spitzer,” said Belth, a professor emeritus of insurance at the university. “They illustrate how hard it is to accomplish significant and lasting reform in the insurance market for the benefit of insurance consumers.”

Earnings Boost

Fewer restrictions may help boost earnings at the top three brokers over time, said Meyer Shields, an analyst at Stifel Nicolaus & Co. Marsh & McLennan, the second-biggest broker, and No. 3 Willis rose the most in about two weeks on the New York Stock Exchange yesterday, while No. 1 Aon advanced 1 percent.

“For the big three brokers theres definitely upside,” Shields said in an interview.

Contingent commissions, which insurers pay to entice brokers, vary in amount based on the quantity of coverage sold by the middleman and how profitable the policies turn out to be for carriers. In 2004, Spitzer called some contingent commissions “classic cartel behavior.”

Spitzer left his post without extending the fee ban to all smaller agents. He went on to become governor of New York, a position he resigned in 2008 amid a prostitution scandal. In the last two years, Aon, Marsh & McLennan and Willis called for common rules to be applied to all middlemen.

Appeal

Marsh & McLennan and Aon appealed to officials for redress in 2008 as regulators opened a review. No. 4 broker Arthur J. Gallagher & Co., which won release in July from a ban of its own, has said it expects to make an extra $10 million annually by again accepting contingent payments. Marsh & McLennan said in 2004 that the payments totaled about $845 million a year, or 12 percent of brokerage revenue.

A group of insurance buyers yesterday criticized regulators for repealing the restrictions and permitting the payments.

Contingent commissions “can be, and were, manipulated at the expense of the insurance consumer,” the Risk and Insurance Management Society said in a statement. “RIMS has strong reservations about a policy that permits contingent commissions again, and this development illustrates why RIMS so vigorously fought for a stronger rule.”

Stocks

Marsh & McLennan gained 39 cents, or 1.7 percent, to $22.78 at 4:15 p.m. in New York Stock Exchange composite trading, less than half its 2004 peak before Spitzer sued the company. Aon rose 38 cents to $40.28, and Willis climbed 37 cents, or 1.3 percent, to $28.25.

Willis Chief Executive Officer Joseph Plumeri said his company wont return to accepting contingent commissions. David Prosperi, a spokesman for Aon, said the broker had “no current plans” to resume the practice. Christine Walton of Marsh & McLennan declined to comment on contingents, saying the company is committed “to serving our clients best interests.”

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Its true that hikes like the one by WellPoint Inc. apply only to people who buy individual insurance and are unlikely to spread to the majority of Americans covered through their employers. But such hikes also hit a huge number of Americans who mostly went unmentioned in the furor - the 46 million with no insurance at all.

Thats because for most people who dont get insurance through their jobs and do not qualify for government assistance, the only option is buying individual policies like the ones in WellPoints Anthem Blue Cross plan, often with high deductibles.

Raise prices, and people without insurance are even less likely to buy it - healthy people especially. Meanwhile, older and sicker customers pay more and more, running up high health bills in a shrinking pool.

That conundrum is at the heart of a disagreement that has frozen Democratic health reform efforts in Congress. Reform bills would require most of the uninsured to buy coverage, an idea many Americans detest as heavy-handed government.

But without sharing costs across the broadest cross-section of consumers and prohibiting insurers from charging people different premiums depending on their health status, the result is a scenario very much like Anthems.

“I know the American people get frustrated in debating something like health care because you get a whole bunch of different claims being made by different groups and different interests,” President Barack Obama said earlier this week in addressing the Anthem hike. “But what is also true is that without some action on the part of Congress, it is very unlikely that we see any improvement in the current trajectory … The current trajectory is more and more people are losing health care.”

Only about 5 percent of non-elderly Americans have individual insurance, compared with 60 percent who are covered by their employers. The remainder is almost evenly divided between those whose care is shouldered by government and those without any insurance at all.

The cost of employer-sponsored health insurance at big companies rose 7 to 10 percent this year, said Tom Billet of Towers Watson, a benefits consulting firm. Preliminary estimates for next year call for roughly the same increase - much lower than the ones set out by Anthem and other individual insurers.

“The individual market is sort of its own animal, so to speak,” he said.

At first glance, WellPoints rate hike affects only a small group - some of the 800,000 people in California who buy its individual coverage. But its also about many more, since just about any American is - or, given the uncertainties of the economy, can be - a candidate for individual coverage at any time.

Millions in group plans have lost jobs and the insurance they count on as a benefit. People in individual plans are trying to keep up with escalating premiums. Some without insurance do so to save money, but as they get older may decide its not worth the risk.

“The result is an insured pool that utilizes significantly more services per individual than under better economic times,” the company wrote in a letter sent to Health and Human Services Secretary Kathleen Sebelius, defending the hike.

“The economic thing makes some sense, no doubt about it,” said Gary Claxton, an expert on the private insurance market at the Kaiser Family Foundation. “If people dont have as much money theyre not going to be as many people who can afford to buy insurance … and the ones who are more likely to do that will always be the healthier ones.”

But Will Dow, a professor of health economics at the University of California, says the rate hike reflects an individual insurance market that is fundamentally broken. Anthem has a reputation for cherry-picking healthier consumers and trying to shake sicker ones, he said.

“Individuals who are in ill health and dont have access to an employer-provided health insurance policy are subject to the mercies of this market, which does not work well for sick people,” Dow said.

That problem is not limited to California or the economic environment of 2010. In Oregon, multiple insurers have convinced state health officials that rising costs justified big jumps in rates the last few years. In Maine, Anthems request to raise rates for some people by up to 38 percent last year and 24 percent this year have angered some politicians and consumers.

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Anthem Blue Cross of California, based in Thousand Oaks, agreed to postpone the increase from March 1 until May 1 so California could have outside experts review the companys complex and detailed plan filing, including data on the medical costs it expects to incur.

The California Department of Insurance had been working with Anthem since mid-November to get more information about the increase, Insurance Commissioner Steve Poizner said. He wanted to have experts comb through the companys figures to confirm the new rates comply with a 2006 state law that insurers spend 70 cents of every premium dollar on medical care.

“Medical cost inflation in California is in the 10 to 15 percent range, so I have a healthy skepticism how they can get to 39 percent” and comply with the law, Poizner said.

If they dont, he said, he will direct the company to reduce its prices, “or I will take away their license to sell insurance” in California.

He officially requested the delay on Monday, but said Anthem stuck to its position that the individual insurance plan had lost money last year and the rate increases were justified - until Saturday. The change of heart came after a week of extensive media reports about the rate hikes, harsh criticism from the Obama administration and two Congressmen scheduling a hearing to look into the rates on Feb. 24.

“They did the right thing today,” Poizner said during a conference call. “These are huge, massive rate increases, very concerning to me and my team.”

The insurance department, which doesnt have legal authority to regulate the rates insurers set, has hired consulting firm Axene Health Partners LLC of Southern California to work with actuaries within the department, review Anthems rate proposal and determine whether it complies with the 70-cent rule. They should finish by mid-April.

Anthem, a subsidiary of insurance giant WellPoint Inc. of Indianapolis, said its proposed rates reflect anticipated medical costs.

“They are actuarially sound and in full compliance with all requirements in the law,” said Brian Sassi, president of Anthem Blue Cross of California.

The company has blamed the increased rates on the recession, rising medical costs and more healthy people dropping out of the plan, leaving fewer premium dollars to cover costs. It has insisted that the situation shows the need for a health-care overhaul that requires everyone to have health insurance.

But Health and Human Services Secretary Kathleen Sebelius said Thursday “it remains difficult to understand” how premium increases of that size can be justified when WellPoint Inc. reported a $4.75 billion profit in the last quarter of 2009.

Anthems plan comes as more people lose employer-sponsored health insurance - and more insurers start raising rates on individual customers.

“We are seeing some significant price increases from other companies” filing new rates for individual insurance plans, which cover about 30 percent of Californians, Poizner noted. He said he did not have details.

Consumers in at least three other states who buy their own health insurance are getting hit with premium increases of 15 percent or more. The Anthem Blue Cross plan in Maine is asking for increases of about 23 percent this year for some individual policyholders. Last year, they raised rates up to 32 percent.

Kansas had one recent case where an insurer wanting to raise most individual rates 20 percent to 30 percent was persuaded by state insurance officials to reduce the increases to 10 percent to 20 percent. The insurance department would not identify the company but said it was not Anthem.

And in Oregon, multiple insurers were granted rate hikes of 15 percent or more this year after increases of around 25 percent last year for customers who buy individual health insurance, rather than getting it through their employer.

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“There are definitely more accidents,” said Rick J. Lindsey, chief executive officer at Prime Insurance Co., based in Salt Lake City. “The jump in claims is directly related to the jump in deliveries.”

The National Football League championship on Feb. 7 could attract 100 million viewers, according to CBS, the television network carrying the game. Super Bowl Sunday is the biggest sales day for the largest U.S. pizza companies, said Jennifer Litz, editor of PizzaMarketplace.com. Dominos Pizza Inc. expects to sell 9 million slices on game night, 44 percent more than a typical Sunday, said spokesman Chris Brandon. Yum! Brands Inc.s Pizza Hut, the largest U.S. pizza chain, expects a 50 percent sales increase.

“Its chaotic and unpredictable,” said Riz Aleem, manager of Papas Pizza in New Orleans. “Its one of the biggest nights of the year like Mardi Gras.” The New Orleans Saints will face the Indianapolis Colts in this years Super Bowl, in Miami.

Pizza delivery is part of a driving-occupation group that ranks as the ninth-most dangerous work segment, just below roofers and power-line repairers, according to the U.S. Bureau of Labor Statistics. There were 22.8 fatalities in the group per 100,000 full-time workers in 2008.

Many More Pizzas

Firemans Fund Insurance Co., a unit of Munich-based Allianz SE, underwrites as much as 20 percent of U.S. pizza delivery policies, said spokeswoman Suzanne Meraz. Claims will rise “just because there are so many more pizzas being delivered on Super Bowl day,” she said in an interview.

Some insurers shy away from the drivers. Allstate Corp. and Progressive Corp., the two largest publicly traded U.S. auto insurers, said they dont insure pizza delivery on personal policies.

“Its a higher risk,” said Allstate spokeswoman Kate Hollcraft. “The kind of exposure that somebody would have delivering pizzas is completely different than one would have in just normal, everyday driving to and from work.”

Underwriters became more selective after a lawsuit related to a 30-minute pizza delivery guarantee by Dominos, said Marla Donovan, a vice president at Burns & Wilcox, a broker and underwriter based in Farmington Hills, Michigan. Dominos paid a $78 million damages award in 1993 to a St. Louis woman whose car was struck by a Dominos driver running a red light. The Ann Arbor, Michigan-based pizza chain shed its guarantee that year.

Money-Making Night

“During the game our phones are nonstop,” Carraway said. “The stores get very excited. They know they are going to make a lot more money.”

Progressive does underwrite pizza delivery on its commercial side, which typically costs more, said Michael Miller, a regional marketing director. Commercial insurers cover the risk with a non-owned auto policy, Donovan said.

State Farm Mutual Automobile Insurance Co., the largest U.S. private-passenger auto insurer, does include pizza delivery coverage in its personal lines, said spokesman Dick Luedke.

Weather, Alcohol

Snow and drunk drivers may also boost claims costs for insurers in coming days. A winter storm watch was posted for New York City and a blizzard warning for southern New Jersey as a system heading for the East Coast threatened to drop more than 2 feet of snow in the Washington-Baltimore area.

“If there is a snowstorm out and nobody wants to go out and pick up their own food, they call for delivery,” said Holly Belknap, vice president at insurance broker Sunderland Insurance Services Inc. in Walnut Creek, California. “The delivery driver is out there driving around in bad weather.”

Almost 50 percent of fatalities occurring on Super Bowl Sunday in 2008 and through 6 a.m. the following day involved an impaired motorist, according to the National Highway Traffic Safety Administration.

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“Members have expressed concern, indecision,” said Durbin, the No. 2 Senate Democrat, adding that talks with the chief party holdout, Senator Ben Nelson of Nebraska, continue. “We wont move forward without knowing we have” the 60 votes that will be needed for passage, he said.

Durbin expressed confidence that Democrats would pass the health bill by Christmas, a goal set by Majority Leader Harry Reid. On the Senate floor, he urged Republicans to work with Democrats for quick approval of the military bill, already passed by the House, so lawmakers could return to health care.

The 10-year, $848 billion Senate health plan is designed to cover 31 million uninsured Americans and curb medical expenses. Like a measure passed Nov. 7 by the U.S. House, it would require Americans to get health coverage, offering expanded aid for the poor and creating online insurance- purchasing exchanges to help the uninsured buy policies.

Read Aloud

Partisan clashes over the legislation broke out on the floor yesterday. Oklahoma Republican Tom Coburn demanded that a Senate clerk read aloud every word of a 767-page amendment by Senator Bernie Sanders, a Vermont independent, that would have opened up government insurance to all Americans.

After almost three hours of reading, and as Durbin convened a news conference to complain about the Republican tactic, Sanders withdrew the amendment. Coburns attempt to object was overruled, and Sanders proceeded to give a fiery speech in favor of a single-payer, fully government-run insurance system.

Later, Reid and other Democrats took to the Senate floor, to show their support as Sanders demanded that the full Senate vote immediately to table a pending Republican amendment by Senator Kay Bailey Hutchison of Texas that was designed to delay tax increases in the measure. Her proposal was defeated, 56-41, and signaled the potential for other Republican proposals to be shunted aside.

McConnell Protests

Republicans, who say the bill might crowd out private insurers, raise taxes and widen the federal budget deficit, left little doubt of their intentions to try to stop it.

Republican Leader Mitch McConnell took the floor to defend his partys right to force a reading of amendments. He protested allowing Sanders to withdraw his amendment, saying “the plain language of Senate precedent” requires that all 100 senators agree before a lawmaker can withdraw a measure.

“The American people are saying, Please dont pass this bill,” McConnell said at a news conference. He said the public is aware of the potential risks of higher insurance premiums and cuts to Medicare spending, which would finance half the legislation.

Public Opinion

McConnell pointed to a Washington Post-ABC News poll that found the publics disapproval of President Barack Obamas handling of health care is at a new high of 53 percent. The Dec. 10-13 poll was based on a survey of 1,003 adults and has a margin of error of plus or minus 3 percentage points.

If the Senate passes its bill, the measure would have to be reconciled with a version approved by the House on Nov. 7.

Senator Joe Lieberman, a Connecticut Independent whose support is crucial because Republicans are united in opposition to the measure, said hes ready to back it after Democrats signaled theyre poised to drop a proposed new government-run insurance program, as well as a plan to expand the Medicare program for the elderly to people as young as 55.

Nelson, who last week tried unsuccessfully to amend the bill to include tough restrictions on abortion funding, said hes examining proposed abortion language that would apply to insurance policies purchased in the proposed online exchange.

Waiting for Feedback

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