“There are a couple of specific reasons continuing to support an effective Medicaid program and an individual market is important, and one of those is its importance to business,” Lansky said .
Approximately 177 million Americans receive insurance through employers. Until now those plans have been largely left out of the debate over the future of the Senate health bill, which would make long-term cuts to Medicaid, the government health program for the poor, and reshape the individual market where people buy their own coverage.
But if the bill is passed and more people are uninsured, or public sector programs facing federal funding cuts decrease their reimbursements, Lansky said hospitals will simply shift those costs onto commercially insured patients — namely employers and employees.
He added that if Medicaid is cut and the individual market doesn’t provide affordable, comprehensive coverage, new workers may delay care until they get a job — which could make workers less productive and also create an initial surge in health-care costs that could increase premiums.
“Any additional cuts to public programs are likely to make additional increases [on costs] to the employer and the employee — at a time that most of us are worried about what we’re spending on health care,” Lansky said.
Until now, big employers have praised elements of the health-care bill that would benefit them and been restrained in any criticism. The U.S. Chamber of Commerce has been one of the few major industry groups to come out in support of the bill. The National Business Group on Health has praised the delay of the Cadillac tax that would have been leveled on generous health-care plans and the greater flexibility in how health savings accounts could be used.
“The biggest impact on employers are the taxes and the added administrative requirements that have been imposed by the Affordable Care Act. We see the changes in those provisions, since they alleviate our concerns, as a good thing,” said Steve Wojcik, vice president of public policy at the National Business Group on Health.
But Lansky said despite those benefits, employers are becoming aware that insurance markets aren’t as siloed as it was once thought.
Commercially insured patients generally pay higher rates for health care — in part to compensate for shortfalls created by public health-care programs and the uninsured. Lansky argued the cost-shifting would likely increase if millions more Americans were to lose coverage, as has been predicted. That could push health-care costs higher in the employer market.
(The most recent version of the Senate health bill has not yet been scored by the Congressional Budget Office, but a previous iteration was predicted to result in 22 million people becoming uninsured within a decade.)
Employers have a natural interest in a healthy workforce. If people delay health care while they are unemployed, they could be less productive — or need more health services — once they do start a new job.
Most large employers have been reluctant to be vocal about any health-care concerns. It’s not their primary business or expertise — and many have other, industry-specific issues pending before lawmakers or the White House that are bigger priorities, so they do not want to use up their political capital by taking a side.
“They’re a little uncomfortable to be in this space; it’s very politically charged. And these companies have no desire to get in the midst of a partisan debate that isn’t their primary issue,” Lansky said. “I think the stakes are very high, and they realize with this issue, it’s at least important to share our perspective — to educate policymakers there are some effects of these bills that may have a larger effect.”