Top ACA provisions employers want to keep


A Willis Towers Watson survey finds that employers see enhancing the employee experience in healthcare as key to boosting health engagement.

With the House passing a healthcare bill to replace the Affordable Care Act (ACA) and awaits passage by the Senate, employers expect to retain some of the ACA’s popular provisions, even if they are not required to by a new law, according to a new survey.

For example, according to the survey by Willis Towers Watson, if unlimited lifetime benefits are repealed, employers are more than three times more likely to keep them in place than they are to reinstitute lifetime dollar limits: 50% versus 15%.


“Many employers are more likely to retain some of the popular ACA benefit provisions because of their positive impact on employee engagement and the potential for changes to be viewed negatively in the context of overall rewards,” said Julie Stone, a national health care practice leader at Willis Towers Watson. “As we see an increased focus on employee productivity, employers will be careful about the implications of change, not just from a dollars and cents perspective, but in terms of employee perceptions.”

In addition, if the requirement to cover contraceptive care at a 100% benefit is repealed, employers are nearly six times more likely to maintain coverage at that level than they are to reduce it: 59% versus 11%.

The survey also found that if the age 26 dependent coverage rule were to be repealed-which is not expected in a potential replacement bill-more than twice the number of employers would keep the eligibility age at 26 than lower it: 48% versus 22%.

When asked, “How likely is your organization to make changes to your current healthcare strategy if the following regulatory changes are made?”, few employers responded that they are likely to modify their current healthcare strategy in response to regulatory changes.

While, the survey was fielded in January, well before details of the current efforts to repeal and replace the ACA were available for review, Stone noted that employers remain committed to employee health coverage.

In terms of impact on strategy, other findings include:

1.    If the employer mandate that requires employers to offer affordable, minimum-value coverage to full-time employees or face a penalty were repealed, 80% of the responds would make no change.

2.    If the current restrictions on stand-alone or premium reimbursement HRAs for active workers were to be eliminated, 83% would make no change.

3.    If the public insurance exchanges were to be eliminated, 89% would make no change.

4.    If future change includes a cap on the tax exclusion for health care benefits, nearly half of employers responding to the survey would plan to revisit their strategy.  Stone expects that should the tax status of health benefits change, the majority of employers are likely to revisit the future role of health care in the overall total rewards strategy.

“The bottom line is that employers remain confident that their organization will continue to sponsor health care benefits to active employees over the next 5 years,” Stone says. According to the survey, 92% are very confident and 8% are somewhat confident.

“Employers remain committed to creating a culture where employees are engaged in their own health as a foundation to sustaining a healthy, productive workforce,” Stone says. “Employers see enhancing the employee experience in healthcare as key to boosting health engagement. Employers are confident they’ll be providing healthcare for the near future and are hesitant to commit to changes until they see the big picture.”

Whatever provisions a new law might include, most employers will stay on their current path of building a high-performing healthcare program, according to Stone. “Improving plan design value and creating program efficiencies will remain core components of an effective long-term health care strategy,” she says.

What will it take to keep these provisions in the health law proposed by the new administration?  

“It seems likely that the Senate will develop an entirely different repeal approach,” Stone says. “It remains to be seen what current ACA provisions will be retained and which will not.”

One factor that will affect specific provisions and the bills overall, she says, is the CBO score, which has yet to be done on the House bill.

These findings are from the Willis Towers Watson 2017 Emerging Trends in Health Survey of 666 U.S. employers fielded in January 2017 to determine how U.S. employers with at least 200 employees use and deliver health care programs and services. The 666 employers that responded represent 9.3 million employees, including 6.5 million full-time employees, across a variety of industries. 




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