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WASHINGTON — Days after the insurance lobby began an aggressive campaign against a Senate plan to overhaul the nation’s health care system, senior Democrats fired back, threatening Wednesday to revoke the industry’s long-standing antitrust exemption.

Health insurance is one of only a few industries exempted from certain federal antitrust regulations, and Sen. Charles Schumer, D-N.Y., said the exemption was “one of the worst accidents of American history.

“It deserves a lot of the blame for the huge rise in premiums that has made health insurance so unaffordable.”

Senate Majority Leader Harry Reid, D-Nev., and Senate Judiciary chairman Patrick Leahy, D-Vt., joined Schumer in a stinging denunciation of health-industry practices, but the insurance lobby dismissed the threat as “a political ploy.”

The dispute came as House leaders pushed off a vote on health care until the first week in November and as Reid and other Senate leaders met for the first time with senior White House officials to discuss how to craft compromise legislation. High on their agenda was the array of contentious matters that must be resolved before a bill can come before the full Senate.

Among them is whether to create a government-run insurance plan, whether to fine people who do not purchase insurance, and whether to require employers to offer coverage to their workers.

Impact disputed

Experts differ on the potential impact of repealing insurers’ antitrust exemption.

David Dranove, a professor of health-industry management at Northwestern University’s Kellogg School of Management, said it could harm consumers because the exemption permits health insurers to exchange information about their medical risks when deciding whether to sell them coverage.

David Balto, a former Federal Trade Commission official, described it differently: “This is a very expansive exemption that costs consumers hundreds of millions of dollars. It permits anti-competitive conduct that would not be permitted in any other market.”

Robert Zirkelbach, press secretary for the group America’s Health Insurance Plans, contested that view.

“The health-insurance industry is one of the most regulated industries in America,” subject to regulators at the federal and state levels, he said. “The focus on this issue is a political ploy designed to distract attention away from the real issues in this debate.”

Fears about high costs of the health care overhaul and mistrust of insurers are rekindling interest in letting the government sell health insurance.

Business groups and conservatives remain steadfastly opposed to government insurance — formidable political opposition that shows no sign of weakening. So advocates are getting creative, trying to reformulate the “public option” in a way that can gain the 60 votes needed to clear the Senate.

Instead of an all-or-nothing approach, they’re trying to provide choices.

What if each state could decide whether to offer public coverage instead of having it decreed from Washington — as proposed by Sen. Tom Carper, D-Del.? What if states had a menu of options, from nonprofit co-ops to using their own employee health plans? What if public coverage were offered only as a backstop in areas where one insurer has a lock on the market?

“We are all talking together, trying to find something that not everyone will love but the entire (Democratic) caucus will come to agreement on,” said Schumer, who for months has been seeking a politically viable compromise.

“It’s going to be something flexible, but not weak,” he added.

Public option top issue

What to do about the public plan is the most politically sensitive issue on Reid’s agenda as he sets out to merge the Finance Committee bill with a Senate health committee version that does include a government option.

Wednesday, top White House aides, including chief of staff Rahm Emanuel and Health Secretary Kathleen Sebelius, traveled to the Capitol to meet with Reid, Democratic Sen. Chris Dodd of Connecticut and Finance Committee chairman Max Baucus, D-Mont., about combining the Finance bill with the Senate health-panel measure.

Reid is giving no hints. Asked Wednesday if he thought it was likely there would be a public plan in his merged bill, he responded: “I’m not betting on health care. ‘Likely’ is in a game of craps.”

Republicans say the fix is in for a public plan. Behind the scenes, Democrats will take Baucus’ middle-of-the-road plan and turn it hard to the left, they say.

“We know that the bill written behind closed doors here in the Capitol will be another 1,000-page, trillion-dollar Washington takeover,” said Senate Republican leader Mitch McConnell of Kentucky.

The Associated Press contributed to this report.