While employers can calculate – or at least try to – the number of employees who will be newly eligible for health insurance coverage under the Affordable Care Act on Jan. 1, they have no way of knowing how many will actually elect coverage. More companies are foreseeing a negative cost impact from the ACA, according to research from Mercer released Wednesday, and nearly a quarter are still uncertain how they will track wage earners who work variable hours.

In the survey of nearly 900 employers, 9% of respondents say ACA will have little or no cost impact on their bottom line (adding less than 1%), down significantly from the 25% who thought so in 2011. Two years ago, 15% expected costs to rise significantly (to the tune of 5% or more); today, that number is 19%.

“As we approach 2014, it's a bit concerning that 32% of employers know little about the actual cost impacts of the new changes,” says Mercer president and CEO Julio A. Portalatin. “The Affordable Care Act affects each organization differently as the impact on many fronts will persist well beyond the 2014 period with many variables to consider.”

Several firms are bracing to protect themselves from increases in enrollment with higher employee contributions, especially for dependent coverage. Thirty percent of those questioned say they will ask for bigger paycheck deductions for dependent coverage next year, and 13% will increase the contribution for employee-only coverage. Twenty-three percent still don’t know how they will track variable-hour workers, as required by law, to get to the magic number of 30 hours a week.

“Tracking employee hours and maintaining accurate records will be critical for employers, since they will need access to this information later in the event of an audit or to defend themselves against penalties for 2014 and beyond,” says Tracy Watts, Mercer’s health care reform leader.

When employers were asked if they were budgeting for an increase in enrollment in 2014, 17% said yes, 42% said no and 41% are unsure.

Employers are, however, looking ahead to the “Cadillac tax” on high-cost plans that goes into effect in 2018. Over a third of respondents say they have already begun taking steps to avoid the provision, which would charge companies a 40% excise tax, for health care plans at or above $10,200 for an individual and $27,500 for a family in 2018. “This provision,” Watts says, “could be the real game-changer,” and more employers are eyeing high-deductible consumer-driven health plans because of it.

“Employers have consistently told us that they will do whatever is necessary to avoid the tax,” she says, “and given the rate of increase in health benefit cost, that may require fundamental changes in the type of health benefit they provide and how they provide it.”

Only 7% of employers with 500 or more workers are planning on exiting the employer-sponsored game entirely, Mercer says. About a third, however, are considering offering a private exchange within two years (32%), and even more are weighing that option within five years (47%).

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