When the public exchanges were first envisioned, some industry analysts thought most employers eventually would head for the exits on financing health benefits and simply steer their employees into the nascent online marketplace. That hasn’t happened, of course, and it’s far too early in the HIX rollout to expect any meaningful change to occur.

But the notion was given fresh legs by Ezekiel Emanuel, a physician, academic and former White House adviser who was instrumental in helping conceive the Affordable Care Act. He recently predicted that private-sector workers who receive health care from employers will fall below 20% by 2025 from the current 60%.

Emanuel lauded a significantly diminished role for employers as a way to rein in costs and enhance consumer choices in his new book, “Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.”

Dismantling employment-based health care delivery, often called an accident of history rooted in World War II wage controls, represents a terribly myopic view, counters Thomas Parry, president and CEO of the Integrated Benefits Institute, which provides health and productivity research, measurement and benchmarking.

Proponents of this approach “fail to understand that employers provide a setting within which employee health can be supported,” he said in a recent statement. “Employers must understand that there is a critical difference between their decisions about financing health care, and their decisions about managing workforce health and its business-performance outcomes.”

Also see: Look beyond health care financing to workforce health

Solving the nation’s health care crisis transcends the extent to which employers will decide in the future to finance health care for their employees “through direct benefits or the tax system,” adds Parry’s colleague, IBI’s executive vice president Kim Jinnett, Ph.D, The chief objective is to adopt an investment mentality that uses health promotion as a tool to attract and retain employees.

She says employers have been distracted for years by a medical spend that involves “the largest increase in cost of any other industrialized nation,” though it’s a tiny part of the overall equation in terms of improvements in health status and workforce health. “So in some ways,” Jinnett opines, “this opens an opportunity for employers to think about different options they have and maybe focus more on managing workforce health rather than how much they’re spending here and there.”

Also see: Health costs pushing U.S. economy ‘off the cliff’: NBCH CEO

One such method at their disposal is direct payment for benefits. “You can have an onsite clinic, for example, and still send your employees to exchanges,” she says. “Ultimately, what we’re trying to help employers understand is investing in their employees, just like they might invest in equipment, is going to help their business in the long run.”

Jinnett explains that beyond determining what kind of health plan designs to offer, employers can do more to move the needle on costs if they foster a culture of health that supports healthier choices and environments during the course of a workday. Consistency is another area of importance. If a wellness plan is promoted, for instance, she says flexible schedules should be in place so that individuals can take full advantage of the initiative.

If an investment in employee health is seen as a mechanism to improve business performance, then Jinnett believes employers may not be so distracted by the associated expenses. It’s part of recognizing that “the health of their workers does matter for their business,” which she says also enables them to have more control.

Bruce Shutan is a Los Angeles freelance writer.

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