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Business Round Table, John Engler, President

The Business Round Table is an association of U.S. CEOs whose companies bring in nearly $6 trillion in annual revenues and employ more than 13 million workers. The conservative trade group believes the passage of health care reform was “just the first step in reforming our nation’s health care system. There remain many challenges ahead as we work to create greater efficiencies and capture savings.”


Group president Engler, reports that “BRT is engaged in the implementation process and in identifying areas where legislative or regulatory changes are necessary.” He insists that “any serious discussion of cost containment must include medical liability reform.”

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AARP, John Rother, Executive Vice President

“The cost of health care is a function of the way medical services are delivered in the community, the incentives for providers, and the structure of insurance (i.e. cost shifting to cover the costs for the uninsured),” explains Rother, who points to areas benefit sponsors might influence regardless the direction of federal law.


“Many employers have shown success with on-site nurse-staffed clinics and exercise programs, healthy food choices, and information designed to support healthier lifestyles,” he observes. “Chronic conditions are a particular concern, and many are responsive to early detection and interventions. Intensive management of high cost patients has also been shown to lower overall costs, but requires physician extenders, patient engagement, and changes in insurance to lower cost-sharing in order to succeed.”


To view a video of Rother discussing the future of health care reform click here.

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National Business Group on Health, Helen Darling, President and CEO

Darling believes “[The] number one issue for employers is employee engagement: engagement in controlling costs and in taking responsibility for improving their own health. If employees don’t understand what is driving health care costs and what they can do to control them, then employees will pay more and more for health benefits and employers will too.”


She observes that some 60% to 80% of health problems are preventable and are directly related to choices people make. “For example, they are not: eating the right food in reasonable amounts, being physically active, wearing seat belts and helmets, not smoking and drinking in moderation.”


To deal with reform and combat costs, Darling says “employers must have a comprehensive health care, wellness and benefits strategy” that uses an aggressive cost management and health improvement strategy. In addition, she recommends “sourcing for best in class vendors who provide the best networks, best care management, centers of excellence, and care and disease management that are highly targeted,” as well as measuring results with sophisticated data warehouses.

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Society for Human Resource Management, Hank Jackson, President and CEO

Overall, Jackson and SHRM “recommend employers offering health care coverage to take a long-term perspective on the issue of reform and plan design. Specifically, the bottom line is that employers need to ask themselves ‘what role do I want health care playing as part of my total compensation package in 3 to 5 years?’ Once an employer makes a decision on that fundamental issue, making decisions about plan design and structure becomes easier and helps to guide the process.”


He adds that “the other major tool an employer can use for managing health care costs and reform issues is communication. Communicate and educate your employees, your senior management team and other stakeholders about your plan and the “cost drivers” of the plan and the role the staff can play in controlling cost. One effective tool in controlling costs and in educating staff about their own role in health care is through the use of wellness program.”

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Center for Health Policy Research and Ethics, Len Nichols, Director

Nicols distinguishes between long-run and short-run recommendations for employers. “In the near term, adopt value-based design benefit packages with smart, evidence-based cost-sharing, make workers aware of how much higher take-home wages (or lower employee premium contributions) could be if health care costs grew slower, and let them see use and price trends so they can see how smarter use patterns and trends would be mutually beneficial.”


“In the longer term,” the George Mason University Professor of Health Policy advises employers “to demand, join, and support multi-payer payment reform efforts to align incentives across the delivery system so that providers, payers, and workers share and are all incentivized to create savings off baseline spending trends. I would also focus on wellness and prevention programs, some of which have good evidence now and can create both productivity gains and lower cost trends over time.”

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America’s Health Insurance Plans, Karen Ignagni, President and CEO

AHIP is a national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans. It was a staunch opponent of the Patient Protection and Affordable Care Act. Ignagni said that while “the access expansions are a significant step forward…this legislation will exacerbate the health care costs crisis facing many working families and small businesses.”


Some reforms may be possible irrespective of the law, says a spokesperson for Ignagni. In the private sector, for example, there needs “to be greater coordination of care for patients with multiple chronic conditions;” pay for performance for physicians and hospitals; and patients must be “incentivized to support healthier lifestyles.” The latter point is one direction employers could directly influence.

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Employee Benefit Research Institute, Dallas Salisbury, President and CEO

Salisbury, the leader of the nonprofit, nonpartisan research institute, advises employers to “work backwards from effective dates [in the reform law] and spend time and money only as required to make the deadline.” He cites the Cadillac tax, which is effective in 2018, and probably will never go into effect because more tax treatment change for health benefits is likely long before the tax is effective.


So, if there are no good legal or accounting reasons to spend time on it, “don’t waste the time or money. Making changes now in the theory that it will keep you below the threshold will prove to be the same total waste of money as was Section 89 preparation before its ultimate repeal. Health reform will be most prudently approached with ‘just in time implementation’ so that anything that is repealed or declared null and void will not have absorbed time and money.”

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Center for Studying Health System Change, Paul Ginsburg, President

Though some analysts say employers should plan as if health reform were here to stay, Ginsburg observes that the most significant changes will not have to be made before the second half of 2013.

“This means employers can wait until the dust clears on constitutional challenges to the legislation and to see whether significant modifications emerge from this Congress or the next one.”


He does acknowledge that the employers will have an important decision on whether to offer health insurance and whether they should self-insure.


“Large employers will prize the fact that being self-insured avoids a key excise tax and keeps their employees outside of a risk pool that might be less favorable. Some medium-sized or even smaller employers will pursue self-insurance for these reasons. For others, the choice will be whether to continue providing health insurance now that (as of 2014) their employees can do much better as individuals than they have been able to in the past. Some will buy coverage on the insurance exchanges and allow their employees to choose a plan. Others will drop their coverage and increase cash compensation,” explains Ginsburg.


The HSC is a nonpartisan center that conducts health policy research and analysis focused on the U.S. health care system.

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