Employer health benefits have been a middle-class mainstay since World War II, when companies were encouraged to offer health insurance instead of pay raises. About 150 million workers and family members are now covered.
When lawmakers debated the legislation, the nonpartisan Congressional Budget Office projected it would only have minimal impact on employer plans. About 3 million fewer people would be covered through the job, but they'd be able to get insurance elsewhere.
Two provisions in the new law are leading companies to look at their plans in a different light.
One is a hefty tax on high-cost health insurance aimed at the most generous coverage. Although the "Cadillac tax" doesn't hit until 2018, companies may have to disclose their exposure to investors well before that. Karen Forte, a Boeing spokeswoman, said concerns about the tax were partly behind a 50 percent increase in insurance deductibles the company just announced.
The tax is 40 percent of the value of a plan above $10,200 for individual coverage and $27,500 for a family plan. Family coverage now averages about $13,800.
White House adviser Furman said blaming a cost increase next year on a tax that won't take effect for eight years "stretches credibility very far past the breaking point."
Bigger questions loom over the new insurance markets that will be set up under the law.
They're called exchanges, and every state will have one in a few years. Consumers will be able to shop for coverage among a range of plans in the exchange, with a guarantee they can't be turned down because of an existing medical problem. To help make premiums affordable, the law provides tax credits for households making up to four times the federal poverty level, about $88,000 for a family of four.
Bredesen said last week that employers could save big money by dropping their health plans and sending workers to buy coverage in the exchange. They'd face a fine of $2,000 per worker, but that's still way less than the cost of providing health insurance. Employers could even afford to give workers a raise and still come out ahead, Bredesen wrote in a Wall Street Journal opinion piece.
Employers are actively looking at that. "I don't know if the intent was to find an exit strategy for providing benefits, but the bill as written provides the mechanism," said Deloitte's Keckley, the consultant.