Joseph Frick, chief executive officer of the Philadelphia-based Blue plan, which has 3.4 million subscribers, said he found the "call to action refreshing" and agrees the country needs change now. "We're closer to reform than we've ever been," he said.

Ronald A. Williams, chairman and CEO of Aetna, which has about one million subscribers in the region, called the speech a positive step. "I view it as helping us maintain momentum, and my hope is we get something done here," he said. The country, he said, should "get done as much as we can get done now."

Obama gave insurers one thing they want: support for a requirement that everybody obtain health insurance. His plan also would make it illegal for insurance companies to deny coverage to people because they have been sick in the past or to reduce coverage after they get sick. The industry has supported those changes as long as they are tied to a coverage mandate.

"If folks only have an incentive to get insurance when they have a health crisis . . . then it drives up costs," Frick said.

But Obama also left on the table a public-insurance option for people who are now uninsured - a proposal insurers have said would provide unfair competition for them and lower payments for doctors and hospitals. He estimated that only about 5 percent of Americans would choose that option.

Frick said he worried about whether there could be a level playing field when the government will be both a player and the referee.

Frick and Williams said cost controls based on quality of care were crucial. Frick also said everyone needs to take more responsibility for preventing illness.

Frick, who was diagnosed with colon cancer three years ago after a routine colonoscopy, said he was struck by Obama's remarks about Sen. Ted Kennedy. Kennedy wrote the president in a letter disclosed last night about how his family's encounters with cancer made him contemplate what it would be like to deal with such an illness without insurance. "That really resonated with me on a personal level," Frick said.