By Ricardo Alonso-Zaldivar

The Associated Press

WASHINGTON

You'd think health insurance CEOs would be chilling the bubbly with Republican Mitt Romney's improved election prospects, but instead they're in a quandary.

Although the industry hates parts of President Barack Obama's health care law, major outfits such as UnitedHealth Group and BlueCross Blue Shield also stand to rake in billions of dollars from new customers who'll get health insurance under the law. The companies already have invested tens of millions to carry it out.

Were Romney elected, insurers would be in for months of uncertainty as his administration gets used to Washington and tries to make good on his promise to repeal Obama's law. Simultaneously, federal and state bureaucrats and the health care industry would face a rush of legal deadlines for putting into place the major pieces of what Republicans deride as "Obamacare."

Would they follow the law on the books or the one in the works? What would federal courts tell them to do?

The answers probably would hinge on an unwieldy Congress.

Things could get grim for the industry if Republicans succeed in repealing the Affordable Care Act's subsidies and mandates, but leave standing its requirement that insurers cover people with health problems. If that's the outcome, the industry fears people could get health insurance on the way to the emergency room, and that would drive up premiums.

"There are a lot of dollars and a lot of staff time that's been put into place to make this thing operational," G. William Hoagland, until recently a Cigna vice president, said of the health care law.

Insurers "are not going to be out there saying, 'Repeal, repeal, repeal,'" said Hoagland, who oversaw public policy at the health insurance company. "They will probably try to find the particular provisions that cause them heartburn, but not throw the baby out with the bath water."

The Romney campaign isn't laying out specifics on how the candidate would carry out his repeal promise, other than to say the push would begin on his first day in office. Romney has hinted that he wants to help people with medical conditions, but he doesn't say what parts of the health care law he'd keep.

Likewise, America's Health Insurance Plans, the major industry trade group, isn't talking about what its members are telling the Romney campaign, though informal discussions are under way through intermediaries. Insurers like Romney's plan to privatize Medicare, and some point out that it looks a lot like Obama's approach to covering the uninsured.

Robert Laszewski, an industry consultant and blogger, says the tension is becoming unbearable.

"I spend a lot of time in executive offices and board rooms, and they are good Republicans who would like to see Romney win," Laszewski said. "But they are scared to death about what he's going to do."

There is no consensus among Republicans in Congress on how to replace Obama's law, much less anything like a bipartisan middle ground on health care, a necessity if the House retains its GOP majority and the Senate remains in Democratic hands.

their concern

A key provision of the new health care law requiring people to have health insurance could be thrown out under a Romney presidency, and with it the billions of dollars insurance companies stand to rake in from new customers.