WASHINGTON

AMID ALL THE CONCERN and uncertainly over how the nation should grapple with the economy, including the financial crisis, hopeful signs are emerging on another critically important issue that affects every American: health-care reform. After 15 years of polarized debate and inaction, a consensus is beginning to take shape that we can cover all Americans, improve the quality of care, and begin slowing the growth of costs — while preserving what works best about our health-care system.

Our optimism is based in part on what we heard from people in Rhode Island and across the country over the past year.

During a nationwide listening tour, we, representatives of the health-insurance industry, came to Providence a few months ago to meet with working families, small-business owners, labor leaders and health-care advocates. We heard what is on the mind of Rhode Islanders, starting with affordability for small business, portability for those changing jobs, improved quality and more transparency.

These discussions enabled us to better understand the health-care concerns and experiences of the American people and to get feedback on the reform ideas that we have offered over the past three years.

We recently announced a new comprehensive proposal to achieve universal coverage, reduce the growth of health-care costs, and improve quality and value throughout the health-care system. This new plan directly addresses the concerns we heard in our listening tour roundtable discussions.

Our proposal builds on and strengthens the present employer-based system, guarantees that coverage is available for all, shores up the health-care safety net, and makes coverage more affordable and more portable for working families and small businesses.

We listened to concerns about access to health insurance for early retirees and people with pre-existing medical conditions who do not have employer-provided insurance. To address this, we propose guaranteed coverage for all as part of a universal participation plan in which all individuals are required to maintain health insurance.

There is no question that the American people want the security and peace of mind that health insurance provides; however, it is not realistic to expect everyone to have coverage unless that coverage is affordable. We propose a new refundable, advanceable health-care tax credit for individuals and families who earn up to 400 percent of the federal poverty level. This helping hand from Washington would enable hard-pressed, middle-income Americans to more easily afford to get — and keep — the health-care coverage they need.

Nearly all Americans agree that the nation needs a much stronger health-care safety net. We propose that Congress make eligible for Medicaid every uninsured American living in poverty and strengthen the Children’s Health Insurance Program to cover all uninsured children from low-income families.

Health companies have also proposed an innovative way to make coverage more affordable and more portable for the uninsured, people who are changing jobs and small employers: a new essential-benefits plan that would be available in all 50 states. This new plan would cover prevention and wellness as well as acute and chronic care, but to maintain affordability, it would not be subject to varying and conflicting state benefit mandates.

We believe the American people understand that health-care reform will only be sustainable if the nation gets serious about addressing health-care costs. We propose that Congress set a bold goal of reducing the growth of health-care costs by 30 percent, which would save more than $500 billion over the next five years. We are also urging Congress to establish a public-private advisory board to provide objective, independent expert recommendations on how to achieve these targets.

A new national strategy to drive down costs should include: changing the physician payment structure to better reward value and quality; expanding programs that coordinate care for patients with chronic conditions; promoting prevention, wellness, and early intervention; and making investments in health-information technology.

Study after study has shown that many medical treatments are unwarranted or ineffective — putting patients at risk and driving up costs. The nation can no longer afford to forgo evaluating and comparing the effectiveness of competing technologies and medications. We believe every patient and physician must have access to clear, consistent and independent guidance about best practices and which treatments work best.

We came away from the listening tour convinced that the American people are ready for a renewed national conversation on health care. We also believe there is far more common ground on health-care issues than is widely perceived. Most Americans are supportive of a blended public-private health-care system, and they want both sectors — the government and the marketplace — to work better and cost less. Real reforms are within reach. The nation’s current economic challenges only reinforce the need to act.

Are health-insurance companies committed to this cause? The answer is emphatically yes. As an important part of the health-care delivery system, we understand that we have a special responsibility as the nation takes up health-care reform. We intend to earn our seat at the table. We will offer solutions, collaborate with others, and stay at it until the job is done.

Karen Ignagni is president and chief executive of America’s Health Insurance Plans, the national trade association for insurance companies.