Large employers are playing a waiting game in the coming year on health care cost saving strategies as many wait and see how Washington politics play out.

2018 is a key year for many employers as the Affordable Care Act’s excise tax on high-cost plans takes effect, and many employers have been opposed – with a majority of employers noting that at least one of their plans will trigger the tax by 2020, due to the difference between overall inflation and medical inflation.

And there has been a move on Capitol Hill by both Democrats and Republicans to repeal the tax. The idea of congressional action is enticing some employers to hold off from making and immediate changes to current health plans, according to fresh data from the National Business Group on Health.

Also see: IRS issues ‘first taste’ of Cadillac tax implementation

The number of employers moving to replace their plans with high-deductible health plans has remained rather flat, at 33%, despite the impending tax.

“Companies are looking to Washington and waiting to see if the Cadillac tax is removed,” said Brian Marcotte, NBGH president and CEO in announcing the release of the group’s annual survey of large employers. “This year is going to be quiet,” he added.

And although employers can only wait so long until the excise tax take effect, many have taken several varying initiatives to stem health care cost increases, including full-replacement CDHPs, offering CDHPs as an option, increasing employee cost-sharing, disease management and wellness initiatives.

However, Marcotte said, the successful employers mitigating costs the best are not focusing on just one thing, they’re investing in everything.

Also see: How to avoid getting run over by the Cadillac tax

Almost one-half of respondents (48%) expect at least one of their benefit plans will hit the excise tax threshold in 2018 if they don’t take action. By 2020, almost three-quarters (72%) expect one of their plans will trigger the tax, while their plan with the greatest enrollment will trigger it only a year later.

And as employers anticipate annual enrollment, “there is a lot at stake,” Marcotte said.

Employers are planning a number of changes, the study notes, including spousal surcharges, and more and better access to health care resources such as nurse coaching and decision-making tools.

Also see: Cadillac tax: A huge car wreck for employers?  

In addition, employers can expect a bigger focus on the pharmacy side of health care.

Overall spending on prescription drugs continues to grow and is expected to increase 10.6% per member, per month in 2016 — with much being attributed to rising specialty pharmacy costs, added Karen Marlo, VP of benchmarking and analysis at NBGH. 

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