Big employers are pretty sure they鈥檒l keep offering workers health care coverage. But they seem a lot less sure than they used to be, .
Much of the doubt reflects 鈥渢he uncertainty around the long-term implications of the Affordable Care Act,鈥� said Julie Stone, a benefits consultant at Towers. While problems with the the health law鈥檚 online marketplaces ensure most companies don鈥檛 see them as an alternative to traditional coverage anytime soon, she said, 鈥淚 wouldn鈥檛 rule out that in the five- to ten-year time range, if they鈥檙e operating more efficiently, certain organizations who don鈥檛 view health benefits as core to their employee value proposition [will] take a different approach.鈥�
Costs for employer health plans continued to rise slowly compared with those in previous years. But they still went up by far more than overall price inflation, adding new burdens to companies as well as employees bearing more and more of the expense.
Health-related deductions from worker paychecks have been rising on average by about 5 percent a year, she said, adding: 鈥淪alaries certainly haven鈥檛 gone up 5 percent a year,鈥� Stone said.
Counting premium contributions as well as deductibles and other out-of-pocket costs, employees are expected to pay 37 percent of all expenses incurred by big-company health plans this year,聽according to the Towers/NBGH survey of 595 companies employing at least 1,000 workers.聽That鈥檚 up from 34 percent in 2011. The average employee pays $1,200 more a year for health care than she did only three years ago, the report said.
Part of the change has to do with the switch to high-deductible plans using pre-tax health savings accounts or something similar. Such 鈥渁ccount-based health plans鈥� come with 鈥� what the employee and her family pay before insurance kicks in.
Median enrollment in such plans rose from 15 percent in 2010 to 33 percent this year, the survey found. One company in seven offered only a high-deductible plan last year. By 2015 it could be nearly one in three, Towers said.
While 95 percent of the companies said subsidizing employee health coverage will be 鈥渧ery important鈥� in 2015 and beyond, nearly as many expect to make moderate to significant changes in their plans by 2018.
Many are starting already.
Nearly half the respondents now require higher employee contributions for spouses and children than for the employee. Only a little more than half the companies said subsidized coverage for spouses would be a very important part of their benefits package in 2015 and afterwards.
Companies are looking hard at private exchanges 鈥� online insurance marketplaces similar to the health-law portals 鈥斅爎un by benefits pros and offered to select employers. Under private exchanges, companies still sponsor the coverage. But they typically give workers a fixed amount to shop for plans among several insurers, leaving much of the enrollment and administration to somebody else.
Employers are embracing private exchanges most quickly for retiree coverage. But most are taking a 鈥渨ait-and-see approach鈥� on steering active employees to private exchanges, said聽Helen Darling, president and CEO of NBGH.聽(Towers Watson .)