As the nation struggled with rising health care costs and a lingering recession last year, the nation's five largest health insurance companies racked up combined profits of $12.2 billion - up 56 percent over 2008, a coalition of liberal advocacy groups and labor unions said. At the same time, the coalition's report said, insurers WellPoint, UnitedHealth Group, Cigna, Aetna and Humana covered 2.7 million fewer people than they did the year before. The report Thursday said three of the five insurers cut the proportion of premiums they spent on their customers' medical care, committing relatively more to salaries, administrative expenses and profits. Prepared by Heath Care for America Now, the report was based on company annual financial reports for 2009 filed filings with the Securities and Exchange Commission. Industry representatives criticized the report, saying that 2008 was a bad year financially across many industries, skewing the 2009 comparison. "It is disingenuous to look at the profits at one company today compared to where it was in the depth of a recession," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans, the industry's Washington-based lobbying arm.