By Peter Frost
Chicago Tribune, July 3, 2012
Many Chicago-area employers have remained on the sidelines with their employee health plans, waiting for the U.S. Supreme Court to determine whether the 2010 health care overhaul passed constitutional muster.
But with the court’s decision last week to uphold most of the law, companies may pursue a historic change.
Many employers are quietly considering a move away from traditional defined benefit plans and toward defined contribution plans, which set aside a fixed amount of money each year for employees to use toward health care costs.
Under the structure of defined contribution plans, companies hand an employee a set amount — say $9,000 — and employees use that money to buy or help pay for a health insurance plan they choose themselves.
At the heart of the shift is a desire of companies to reduce their exposure to health care costs by shifting the risk of unpredictable expenses to their workers.
Few employers, particularly large companies, are eager to discuss their internal deliberations on the issue because they don’t want to raise concerns among employees before final decisions are made, said Paul Keckley, executive director of the Deloitte Center for Health Solutions, the health care research arm of consulting firm Deloitte LLP.
“The only thing that’s certain right now is (companies are) doing everything that’s legal to shift cost to employees,” Keckley said.
Employees of companies that pursue the defined contribution route may be funneled into so-called corporate health care exchanges, which function in much the same way as state-run exchanges.
The private exchange market “is really emerging and growing, largely because of all the interest in the state exchanges,” said Michael Thompson, a principal in PricewaterhouseCoopers LLC’s global human resources practice.
Inside the exchanges, employees will be offered more choices on what types of coverage they desire — and how much they’re willing to pay.
“If you value broad access and you’re willing to pay for it, that’s fine,” Thompson said. “If you’re willing to live with a narrower network (of providers) and possibly a higher deductible, you would have the ability to save significant money on your premiums.”
On private exchange GoHealth.com, consumers can shop and ask for advice. Michael Mahoney, GoHealth’s vice president of marketing, said the company has explored a corporate health care exchange for its employees, but it will continue offering its “traditional and robust” health insurance plan for the time being.
His reason? “If you give control to the employees, they could choose to save money and possibly choose something where they’re not completely covered, so they end up in a pinch. Right now, we’re going to overspend on our employees and give them more than they want so they’re always covered.”
By Don McCanne, MD
Just as they did with employee pension plans, employers are now gearing up to convert employee health benefit programs from defined benefit to defined contribution. What does that mean?
Over the past few decades, employers passed on the risks of their pension plans to their employees by switching from a defined benefit (a guaranteed dollar amount that employees would receive monthly in retirement) to a defined contribution such as 401(k) plans (a set dollar amount contributed to the pension account, but with no guarantee of the amount received in retirement – the employee thus bearing the full risk of the uncertain investment returns on the pension funds).
Now many employers plan to do the same with their health benefit programs. They intend to pay a set dollar amount for the premiums, whereas the employees will have to bear the the costs of health care inflation plus the costs of any benefits in excess of the basic program to be offered by the employer.
This will be disastrous. Employees are already being stuck with higher deductibles in order to slow the rate of premium increases for the employer. With defined contribution, premiums can be contained further by limiting the benefits covered, by further increasing the out-of-pocket cost sharing of deductibles, copayments and coinsurance, by tiering cost sharing of different levels of products and services, and by further restricting the panels of approved health professionals and institutions.
When the employee uses the defined dollar amount to purchase plans from the choices offered, but must pay the full balance of the premium, most will choose lower cost plans that place them at very high risk for out-of-pocket expenses should they or their family members need health care. This is the disaster that is pending. Employees will not be able to afford the care that they or their families need, in spite of being nominally insured by their employers.
From a policy perspective, we can understand why employers would want to control their overhead expenses, in this case by protecting themselves from health care inflation, but we can’t understand why policymakers would want to keep employers in charge of health care financing for the majority of Americans, and then add further insult by perpetuating regressive tax policies that favor wealthier employees over those with lower incomes.
With this defined contribution threat looming, we should once and for all remove the employer from the equation. Let’s replace our health care financing system with a much more sensible and equitable single payer national health program, which would remove from employers the burden of having the responsibility of supervising health benefit programs.