Insurance companies are under assault on multiple fronts as consumer advocates demand that regulators deliver on the tougher oversight promised by the federal healthcare reform law.

Consumers Union on Wednesday sent the White House a letter signed by more than 50 organizations demanding that the administration require simple, standardized health insurance forms starting next year, as called for in the law. The letter comes as insurers and some business groups are asking to exclude employer-sponsored coverage from the requirement along with a delay of up to two years.

"Americans need the protection of the [Summary of Benefits and Coverage] provision," the letter says. "It is a widely known fact that Americans often do not understand their insurance coverage or choices available to them. In part, this is because current disclosures are inadequate."

In regulatory comments filed Oct. 21, the trade group America's Health Insurance Plans wrote that the industry has "long supported efforts to provide consumers with clear information about their health coverage options" but that "the proposed rule requires an almost complete redesign of how information is provided to consumers today, and it will be difficult and costly to fully implement in the short time frame."

Separately, California-based Consumer Watchdog on Wednesday filed a ballot initiative that would "make health insurance companies open their books and publicly justify, under penalty of perjury, proposed rate changes before they take effect." The group needs 504,760 signatures by May 1 to qualify the measure for the 2012 ballot.