The health care reform proposals making their way in Congress will threaten the private insurance industry and leave the federal government in charge of health care.

Wait. Let’s try this again.

The health care reform proposals making their way in Congress will force private insurers to be more competitive by lowering their premiums and offering more choices for small-business owners.

Depending on whom you ask, federal lawmakers’ plan to reform health care is either the death knell for the private insurance industry or the shot in the arm it needs. Though insurers have said they are against a government-run insurance plan, many are eyeing new business opportunities as the government is likely to require that all individuals obtain health insurance.

Legislators in the House and Senate are weighing a government-run insurance plan that would compete with private insurers by offering coverage to most of the nation’s 46 million uninsured residents.

More recently in the Hill’s debate, a bipartisan group of U.S. senators has proposed setting up regional health insurance cooperatives that are owned by health providers or consumers that would compete with private insurers. That plan would allow individuals who may not get insurance from their employer to join an insurance pool, thereby spreading the risk associated with covering an individual who has a pre-existing condition.

Some insurers that currently play a small role in Maryland’s individual and small-group health insurance market could grab a bigger slice, depending on what happens on the Hill

Aetna, which insures 300,000 Maryland residents, is looking at ways it can expand its products for individuals and small businesses, Vice President Tom Grote said.

He doesn’t know when or how those new policies will be structured yet, since the debate in Washington is far from over.

Aetna is a minor player in Maryland’s small-group market. Owings Mills-based CareFirst BlueCross BlueShield, the region’s largest insurer, and UnitedHealthcare control 86 percent of the state’s small-group market.

Grote said he envisions Connecticut-based Aetna working with other insurers and the government to create an insurance pool for individuals who have pre-existing conditions.

Cigna, which insures 212,000 Marylanders, will begin offering individual health plans in Maryland and seven other states over the next few months, spokesman Christopher Curran said. It currently offers individual coverage in 13 states.

Meanwhile, CareFirst BlueCross BlueShield also is looking at ways to grow its market share among uninsured individuals, spokesman Jeff Valentine said. The company declined to offer details.

Typically, a company’s health insurance premiums are determined by the age and health of its employees. So one might think that by absorbing more unhealthy people into the insurance pool, premiums will go up for everyone else.

But that probably won’t be the case, said Scott Allocco, president of cancer therapeutics firm BioMarker Strategies LLC, based in Baltimore. Allocco is a former vice president of government relations for Coventry Health Care.