“Wishful” Thinking?

By Nevin Adams, EBRI

Last week the Wall Street Journal reported that Sears and Darden Restaurants were planning a “radical change in the way they provide health benefits to their workers,” giving employees a fixed sum of money and allowing them to choose their medical coverage and insurer from an online marketplace, or exchange1. “It’s a fundamental change,” EBRI’s director of health research, Paul Fronstin, noted in the WSJ article.

Indeed, this is the time of year when many American workers – and, by extension, most Americans – will find out the particulars of their health insurance coverage for the following year. For most, the changes are likely to be modest. And, based on the 2012 Health Confidence Survey (HCS), not only do most Americans seem to be confident in those future prospects, they would seem to be satisfied with that outcome.

More than half of those with health insurance are extremely or very satisfied with their current plans, and a third are somewhat satisfied. Nearly three-quarters say they are satisfied with the health benefits they receive now, compared with just 56 percent in 2004.

Dissatisfaction, such as there is to be found, appears to be focused primarily on cost; just 22 percent are extremely or very satisfied with the cost of their health insurance plans, and even fewer are satisfied with the costs of health care services not covered by insurance. Perhaps not surprisingly, about one-half (52 percent) of Americans with health insurance coverage report having experienced an increase in health care costs3 in the past year, though that was the lowest rate since this question was added to the survey in 2006.

The HCS found that confidence about various aspects of today’s health care system has remained fairly stable2 – and undiminished either by the passage of, or the recent Supreme Court decision on, the Patient Protection and Affordable Care Act (PPACA); more than one-half (56 percent) of respondents report being extremely or very confident that they are able to get the treatments they need, and another quarter (27 percent) report being somewhat confident. Only 16 percent of 2012 HCS respondents said they were “not too” or “not at all” confident that their employer/union would continue to offer health insurance for workers – though that was more than twice as many as expressed that level of concern in 2000.

While respondents were generally supportive of the measures broadening access and/or choice in the PPACA, nearly two-thirds said they hadn’t yet noticed any changes to their health insurance – and among the 31 percent that had, 70 percent said the changes were negative, including impacts such as higher premiums, higher copays, and reduced coverage of services.

Despite a falloff from previous surveys, more than two-thirds (69 percent) of employed workers said that benefits were “very important” in their employment decision, with health insurance topping the list of those important benefits by an enormous margin. Nearly six out of 10 said that health insurance was the most important employee benefit, as has been the case for some time now.

All of which reinforces that, while many see room for improvement in the current system, those that have employment-based health insurance now like it, and want to keep it.

It will be interesting to see if, in the months and years ahead, they get that wish.

Notes

More information from the 2012 Health Confidence Survey (HCS) is online here.  The HCS is sponsored by EBRI and Mathew Greenwald & Associates, Inc., a Washington, DC-based market research firm, and made possible by the generous support of the HCS underwriters, listed here.

 1 More information about private health insurance exchanges is available in the July 2012 EBRI Issue Brief “Private Health Insurance Exchanges and Defined Contribution Health Plans: Is It Déjà Vu All Over Again?” 

 2Asked to rate the health care system, survey respondents offered a diverse perspective: 17 percent rated it either “very good” or “excellent,” 28 percent consider it to be “good,” 28 percent say “fair,” and 26 percent rate it “poor.” However, the percentage of Americans rating the health care system as poor doubled between 1998 and 2004 (rising from 15 percent to 30 percent).

 3Of more than passing concern is the finding that among those experiencing cost increases in their plans in the past year, nearly a third had decreased their contributions to retirement plans, while more than half have decreased their contributions to other savings as a result.

Everybody Into the Pool?

By Nevin Adams, EBRI

Adams

As a teenager, I remember the occasional visits to the local swimming pool. I also remember that about once an hour, the lifeguards on duty would periodically clear the pool, ostensibly to clean out debris, to enforce a certain rest break on the swimmers (and doubtless for the lifeguards), and perhaps to assure that all the swimmers were still able to get out of the pool. Then, after what seemed to my teenage senses like an eternity, the lifeguards would blow a whistle—the “all-clear” signal for everyone to jump back in the pool. They were very strict about this—and kids were routinely banned for an hour, or even the rest of the day for jumping in “early.” As a result, even after the whistle, most of us would hesitate and look around to make sure that we weren’t the only ones going in.

With the Supreme Court’s recent decision on the constitutionality of the Patient Protection and Affordable Care Act (PPACA) behind us, industry surveys suggest that employers are turning to the issue of the next phase of implementation. Moreover, the combination of insurance market reforms and the embodiment of the exchange structure in the PPACA have brought a renewed focus on limiting employer’s health care cost exposure, much as changes in funding requirements and accounting treatment led many to reconsider their approach to retirement benefits.

A recent EBRI Issue Brief¹ notes that it was only about a decade ago that defined contribution (DC) health plans, arrangements that shift choice of health insurance from employers to employees, were the focus of much attention. As far back as the late 1990s, more than 62 percent of health care leaders predicted that employers would move to DC health plans by 2010.

That trend never fully emerged, of course—employers were hesitant to drop group coverage in favor of offering individual policies, some were likely concerned that many employees would not be able to secure coverage in the individual market, some others drawn to the tax advantages. Many viewed the benefit as an important tool in attracting and retaining a strong work force, and surveys, including EBRI’s Health Confidence Survey (HCS), suggest that workers do, in fact, appreciate the offerings.

EBRI’s Paul Fronstin notes that the combination of insurance market reforms and the embodiment of the exchange structure² in PPACA have brought a renewed focus on limiting the employer’s health care cost exposure by providing a fixed-dollar contribution that workers could use to purchase individual policies. He notes that the vehicle that some are interested in using for providing coverage is a private health insurance exchange, through which employers might be better able to accelerate the drive toward a more mass consumer-driven insurance market—and in the process gain more control over their health care contribution costs, while shifting to employees the authority to control the terms (and to some extent, the costs) of their own health insurance.

This should sound familiar to those who have watched similar motivations lead to the shift in retirement plan emphasis from pension plans to defined contribution/401(k) retirement benefits. The question is, will the combination of factors provide employers with the “all clear” sign to undertake changes they have, thus far, been hesitant to take? And if that all clear sign is given, will employers all jump in at once?

 Notes

¹ In addition to a historical perspective, the July 2012 Issue Brief examines the issues related to private health insurance exchanges, the possible structure of an exchange and how it can be funded, as well as the pros, cons, and uncertainties to employers of adopting a private exchange. MORE.

² Fronstin notes that private exchanges are already in development partly because of the uncertainty related to the status of state-based exchanges. Development of several of these were postponed, pending resolution of the PPACA’s constitutional challenge. Several Republican governors have said they will refuse to establish state-based exchanges, leaving them to the federal government to run. As recently as March 2012, the majority of states had still not taken the necessary steps to establish an exchange.

“Macro” Management

By Nevin Adams, EBRI

Adams

Earlier this week, Senate Finance Committee Chairman Max Baucus (D-MT) outlined his overall goals for comprehensive tax reform, noting that he planned to use both the Domenici-Rivlin debt reduction plan and the fiscal recommendations of the president’s Simpson-Bowles Commission¹ as the “starting points for full-scale tax reform,” citing the former in commenting that “‘Everything must be on the table’ when it comes to tax and entitlement reform.” The New York Times on Monday reported a “Push for a Fiscal Pact Picks Up Speed, and Power,” even as other published reports suggested that lawmakers would look to defer those votes until after the November elections.

Those headlines echoed the sense that EBRI CEO and President Dallas Salisbury outlined last month to the EBRI board of trustees at their spring meeting—a sense that broad-based tax reform would be the focus of Congress, with fiscal issues driving a focus on the macro impact of policies rather than the micro outcomes that might result. While there’s an acknowledgement that the “devil’s in the details,” there is also a growing sense that sweeping change is needed, and that—whatever the potential negative effects at the micro level, enacting change would be supported because it was seen as “best for the nation and the economy.”

Salisbury cited a meeting at which a senior congressional staffer noted that when Congress did act, it would include changes in the tax treatment of retirement plans—“we just can’t tell you what.” Later at that same meeting, a more senior official made it even clearer that those issues would be part of the equation, going so far as to outline about a half dozen specific provisions under consideration. Salisbury highlighted as “the most telling words in that senior staffer’s presentation” that “the biggest roadblock to meaningful action toward a rational retirement policy was inter-industry competition”—the competition of firms within the retirement plan industry lobbying for different provisions, all of which carry a cost to the federal government, but with no one willing to suggest ways to pay for their proposals.

“If there is a message,” Salisbury noted, “it is that whatever the government is willing to spend on retirement in the future is less than they are now willing to spend.” Not that there isn’t interest in broader policy objectives, such as increasing the number of individuals covered by retirement programs; however, the sense is that the expense to the government of any new initiatives (such as “automatic” IRAs) would have to come from current tax preferences for other programs. “It’s less than a zero sum game,” Salisbury told the group.

Salisbury cited the comments made by Jim VandeHei, executive editor of Politico, at another recent event, who spoke of a dynamic of policy and party volatility in the near-term, with, at the extreme, control of at least one house of Congress changing every two years for the next decade. VandeHei noted that with the electorate so polarized, at the margins, he expects the presidential election in a number of states to be decided by extremely narrow margins, such as 1,000 to 4,000 votes. Moreover, because of the primary process, the extremes rule in both political parties. The resulting political polarization means that fiscal constraints dominate all discussions on Capitol Hill.

Salisbury noted that proposals to reduce Social Security, the sole source of retirement income for 37 percent of today’s retirees—or Medicare—will widen the current retirement savings gap, as will any reduction in retirement plan tax preferences, or that of workplace-based healthcare programs. “That diminishes an individual’s ability and/or willingness to retire—and that has an impact on employers, and workforce management,” he noted. That also means less capacity in the retired population to consume goods and services—a potentially critical factor in the nation’s future economic growth as well.

As we approach the end of 2012, there is potential for massive political and economic chaos, Salisbury said, because of the concurrent scheduled expiration of the Bush administration tax cuts, the impact of federal budget sequestration and its automatic spending cuts due to hit at year-end, the end of the (extended) payroll tax “holiday,” and the likely need to approve an increase in the nation’s debt ceiling shortly thereafter. The sense is that House Speaker John Boehner (R-OH) will have less control in the next Congress than the current one, assuming Republicans maintain the majority in that chamber.

Meanwhile, in the Senate, regardless of which political party wins control, “60 is the new 50”—meaning that a super-majority of votes will be needed to break a filibuster and pass major legislation..

Salisbury suggested that “it’s all going to happen during the last breathing moments of the current Congress,” reflecting a sense that lame-duck members of the U.S. House and Senate—those who won’t be part of the next Congress—will be willing to cast otherwise politically risky votes in order to make something meaningful happen. The strategy: Let everything “hit the fan” on December 31, which would, among other things, restore higher tax rates. At that point, ANY change that reduces those “new” rates can be seen as a tax cut, rather than an increase. In effect, that means that the current Congress can vote for things on January 2 that would have been tagged a tax hike on December 31, but that on January 2 will be deemed a tax cut. This would all have to occur in the narrow window the end of the year and the start of the new 113th Congress. Newly elected (but not yet seated) lawmakers would not even have to vote, noted Salisbury. (Incidentally, the New York Times reported on a similar scenario this past week, a month behind Salisbury.)

Salisbury said that the highest probability for this outcome is if the status quo emerges from the 2012 election—the Senate split 50/50, the House remains in GOP control, and President Obama is re-elected—“because all three will have a huge stake in things being solved, since they are going to have to live with it over the next four years.”

On the other hand, he noted, if there is a change in the balance of power—such that one party doesn’t have to live with the consequences of it, that the result can be blamed on the other party—lawmakers might defer action.

In any event, Salisbury noted that if the 2012 elections produce the “status quo” in party alignments, by early January we will not only know what the Supreme Court has decided on health care, we may know what the tax status is of workplace benefit plans and programs like Social Security and Medicare—and then the nation’s employers will know what they’re dealing with. But if action is deferred, there will be no letup from uncertainty.

“The macro, not the micro, is driving policy,” Salisbury noted. “This is about saving the economy.” But with everybody focused on macro, he added, “HR execs will have to deal with the impact on the micro.” And, with trust in employers very high by both current workers and retirees, “individuals are likely to turn to employers even more than they do today to help them achieve health and financial security, including retirement security.”

Notes

¹ EBRI has run multiple simulations on these proposals, and their potential impact on retirement savings. See EBRI Notes, March 2012, “Modifying the Federal Tax Treatment of 401(k) Plan Contributions: Projected Impact on Participant Account Balances;” EBRI Issue Brief #360, July 2011, “Employment-Based Health Benefits and Taxation: Implications of Efforts to Reduce the Deficit and National Debt;”  and EBRI Issue Brief #364, November 2011, “Tax Reform Options: Promoting Retirement Security.”

New Health Law Increased Insurance Coverage of Adult Children

The new federal insurance law has increased the health insurance coverage of adult children between 2009 and 2011, according to a new report by the nonpartisan Employee Benefit Research Institute (EBRI).

The Patient Protection and Affordable Care Act (PPACA) enacted March 23, 2010, requires that group health plans and insurers make dependent coverage available for children until they attain the age of 26, regardless of tax or student status, or dependent status as it relates to financial support. The mandate to offer coverage to adult children ages 19‒25 took effect for policy years that began on or after Sept. 23, 2010, but since January is the beginning of the plan year for many employment-based health plans, many insurers adopted the requirements of the law before the effective date.

To determine whether the coverage mandate had an effect, EBRI examined data from two U.S. Census Bureau surveys (the Current Population Survey, CPS, and the Survey of Income and Program Participation, or SIPP), as well as from the National Health Interview Survey (NHIS) by the Centers for Disease Control. The data indicated:

  • The percentage of persons ages 19‒25 with employment-based coverage as a dependent increased from 24.7 percent in 2009 to 27.7 percent in 2010, according to the CPS.
  • The percentage of individuals ages 19‒25 with employment-based health coverage as a dependent averaged 26.9 percent during January‒September 2010, and increased to an average 27.1 percent during October and November, per SIPP.
  • The percentage with private insurance increased from 51 percent to 55.8 percent, and the percentage uninsured fell from 33.9 percent during 2010 to 28.8 percent during the first half of 2011 among those ages 19‒25, according to data from the NHIS.

“Data from these three surveys show that PPACA has had a positive effect on the percentage of young adults with employment-based coverage as a dependent,” said Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the report.

Full results of the report are published in the January 2012 EBRI Notes, “The Impact of PPACA on Employment-Based Health Coverage of Adult Children to Age 26,” online here.

Employer and Worker Reactions to Health Care Reform

The January 2011 EBRI Notes  examines how employers might respond to health reform and employees’ expectations of changes to health coverage.

January 2011 EBRI Notes

As the Notes article details, both employers and workers say they are not very knowledgeable about health reform, but that employers say they are likely to pass along any health benefit cost increases to workers—and, mostly, workers are expecting such cost increases.

The findings are from the 2010 EBRI/MGA Consumer Engagement in Health Care Survey and the Society for Human Resource Management’s 2010 SHRM Organizations’ Response to Health Care Reform Poll.

Concerning the future of coverage, employers are evenly split as to whether they will change health coverage as a result of health reform while workers are split between thinking their benefits will remain the same or erode.  While few workers expect employers to drop coverage after 2014, and very few employers plan to drop coverage, employers are evenly split between having decided to continue to offer coverage and being undecided about the future of employment-based health coverage.

The full report is online here.  The press release is online here.