What Employers Want in Health Reform

Respondents to a survey from Mercer reported preferences for policies to mitigate costs.

Even though President Donald Trump’s efforts to repeal and replace the Affordable Care Act (ACA) seem to have stalled for now, specific changes to the law are still being discussed in Congress and the president’s administration may have a huge influence in how regulations are enforced.


And in the midst of the fierce, ongoing battle for the future of America’s health care system, benefits administrators are voicing their concerns.


Considering the rising costs of health care, respondents to a survey from Mercer reported preferences for policies to mitigate costs. More than nine out of 10 (92%) wish to permit increasing contribution limits toward health spending accounts, which include tax-favored health savings accounts (HSAs). The majority (87%) also wants to raise that threshold to the out-of-pocket maximum. Meanwhile, 66% want medications and treatments for chronic conditions to be covered in an HSA-eligible plan before the deductible is met. Mercer notes this change would make enrolling in a high-deductible plan an easier choice for employees with chronic conditions.


The majority of employers (76%) have adopted high-deductible health plans (HDHPs) to mitigate exposure to the ACAs excise (or Cadillac) tax. Nearly half (49%) have also taken steps to boost enrollment in such HSA-eligible plans, and another 23% plan to follow suit. Respondents also said they are stepping up efforts to control costs without cost-shifting to employees (47%). However, 43% said they are increasing employee cost-sharing requirements. In addition, 23% have eliminated a high cost plan, and 26% have eliminated or reduced retiree coverage.


Respondents shed light on what is driving up costs the most, and 86% said their biggest concern is the price of specialty drugs. Other worries include high-cost claims (74%), the increase in frequency of specific diseases (56%), waste in the system (42%), ACA mandates (33%), and over-utilization of services by members (19%).


However, the survey also found that value-based care is increasingly being seen as a form of cost management. When asked if they believe the Centers for Medicare and Medicaid Services’ (CMS)’s announcement to eliminate specific programs aimed at moving Medicare away from a traditional fee-for-service model would affect their efforts to expand their own value-based care arrangements, 53% said it would not slow them down. Twenty-five percent said they believe employers will even “step up their efforts in promoting provider payment arrangements that reflect the value of services rather than just the volume.”


The Mercer study was conducted among nearly 300 health benefit professionals who answered a five-question survey, and was fielded for 10 days.  More information about the study can be found at mercer.us.