SHRM Poll:
Health Care Reform: Where Are Organizations
in the Decision-Making Process?
February 7, 2011
Health Care Reform Series: Poll 3
Introduction
Landmark legislation that brought about major reforms in health care coverage in the
United States was enacted in March 2010. The law affects employers and HR
professionals in a variety of ways. SHRM will be conducting a series of polls on health
care reform and its implications for employers and employees. This presentation covers
the findings from the third poll in this series, which was conducted in December 2010.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Key Findings
•
•
•
•
Will Organizations Drop Health Care Coverage? One-half of organizations (51%) have decided
not to drop health care coverage for employees as a result of the health care reform law. Of these
organizations, 24% made this decision without conducting an analysis to determine whether to
continue offering health care coverage or to drop coverage and pay opt-out fines. Twenty-seven
percent did conduct such analysis and decided not to drop coverage. Nearly one-third of
organizations (27%) are still conducting or plan to conduct an analysis on the impact of health care
reform.
Many Organizations Waiting on Regulatory Guidance. Nearly one-half of organizations (48%)
indicated that they are waiting on regulatory guidance or information on specific provisions in the
health care reform law to make some health care decisions for their organizations.
What Are the Implementation Barriers? For a number of provisions in the health care law that will
take effect between 2011 and 2018, 27% to 65% of organizations reported that there are no
implementation barriers for their organizations. Of the organizations that reported implementation
barriers, 54% reported the cost of including benefits for adult children up to age 26 (2011) as an
implementation barrier. In addition, one-third (34%) of organizations reported employee out-ofpocket expenses as an implementation barrier to their organization putting into action the exclusion
on purchasing over-the counter medications using flexible spending account (2011).
HR Knowledge About Law’s Specifics Steadily Increasing. The percentage of HR professionals
who are comfortable with their level of familiarity with the health care reform law increased from
48% in July 2010 to 62% in January 2011.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Is your organization engaging in an analysis to determine the impact of
the health care reform law on your health care plan?
Will not conduct an analysis and already decided we will
not drop health care coverage
24%
Already conducted an analysis and decided not to drop
health care coverage
34%
27%
12%
17%
15%
Plan to conduct such an analysis
10%
Currently conducting analysis
Already conducted an analysis and decided to drop health
care coverage
<1%
<1%
Will not conduct an analysis and already decided to drop
health care coverage
<1%
<1%
Unsure at this time
22%
16%
0%
January 2011, n = 677
10%
20%
22%
30%
40%
June 2010, n = 813
• One-half of organizations (51%) have decided not to drop health care coverage for
employees as a result of the health care reform law compared with 46% in June 2010.
Note: Percentages do not total 100% due to rounding. June 2010 data are from SHRM Poll: Organizations’ Response to Health Care Reform.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Is your organization engaging in an analysis to determine the impact of
the new health care reform law on your health care plan?
Comparison by Medical Benefit Funding
Differences Based on Medical
Benefit Funding
Already conducted an analysis and decided not to drop health care coverage
Self-insured (33%) > insured
(20%)
Will not conduct an analysis and already decided we will not drop health care coverage
Insured (31%) > self-insured (18%)
Unsure at this time
Insured (26%) > self-insured (18%)
Organizations with self-insured plans were more likely to have already conducted analysis and decided NOT to drop
health care coverage.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Is your organization waiting to make any health care plan decisions
based on any of the following factors?
Yes
No
Don’t know
Regulatory guidance or information on specific provisions in the health care reform law
48%
42%
10%
Changes to specific provisions in the health care reform law
32%
57%
11%
Repeal of specific provisions of the health care reform law
24%
64%
12%
Repeal of the entire health care reform law
13%
75%
12%
Other factors
13%
53%
35%
Note: n = 617-674. Percentages do not total 100% due to rounding. Data sorted by “Yes” column.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Is your organization waiting to make any health care plan decisions
based on any of the following factors?
Comparison by Medical Benefit Funding
Differences Based on Medical
Benefit Funding
Regulatory guidance or information on specific provisions in the health care reform law
Self-insured (54%) > insured
(42%)
Changes to specific provisions in the health care reform law
Self-insured (36%) > insured
(28%)
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Lack of
support by
employees,
unions or
Management
Limits on deductibles in the small group market (companies with less
than 100 employees) to $2,000 for individuals and $4,000 for families
(2014)
65%
8%
18%
3%
2%
4%
Prohibition on lifetime dollar limits on coverage of essential benefits
(2011)
52%
8%
32%
4%
1%
4%
Exclusion on purchasing over-the counter medications using flexible
spending account (2011)
43%
13%
1%
34%
8%
2%
Inclusion of benefits for adult children up to age 26 (2011)
37%
4%
54%
2%
1%
2%
Employer mandate to provide coverage or pay a penalty (2014)
37%
17%
37%
1%
4%
4%
Excise tax on high-value (so-called "Cadillac") health plans (2018)
34%
19%
28%
7%
8%
4%
Requirement to report the value of an employee's health benefits on
individual employee W-2s (W-2s for 2012 tax year)
30%
17%
38%
2%
6%
7%
Tax form 1099 requirement for all vendor transactions above $600
(2012)
29%
22%
39%
0%
2%
7%
CLASS Act (government-provided long-term care insurance) (20112013)
27%
48%
12%
3%
3%
6%
Note: n = 674-698. Percentages do not total 100% due to rounding. Data sorted by first column.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
Other
Employee
out-of pocket
cost
Lack of
understanding
of the details
of the law
provision
Cost of
implementation
to the
organization
There is no
implementation
barrier for my
organization
For the following provisions of the health care reform law, what do you
see as the main implementation barrier in your organization?
8
What is your level of agreement with the following statement:
"I am comfortable with what I know about the new health care reform law."
60%
54%
50%
45%
41%
40%
32%
30%
20%
11%
10%
8%
6%
3%
0%
Strongly disagree
Disagree
July 2010, n = 774
Agree
Strongly agree
January 2011, n = 679
• The percentage of HR professionals who are comfortable with their level of knowledge about the
health care reform law increased from 48% in July 2010 to 62% in December 2010. This shows that more
HR professionals are quickly familiarizing themselves with the health care reform law, thereby helping their
organizations with the implementation of the law.
Note: July 2010 data are from SHRM Poll: Organizations’ Response to Health Care Reform—Challenges and Actions.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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What is your level of agreement with the following statement:
"I am comfortable with my level of knowledge about the CLASS Act provision
(government-run long-term care insurance) in the health care reform law."
58%
60%
50%
40%
30%
28%
20%
12%
10%
2%
0%
Strongly disagree
Disagree
Agree
Strongly agree
• Only 14% of HR professionals are comfortable with what they know about the CLASS Act provision. Nearly
half of organizations (48%) indicated that lack of understanding of the details of the CLASS Act provision as an
implementation barrier to their organizations.
Note: n = 678
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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What resources is your organization currently using in regard to the
health care reform law?
69%
73%
Insurance broker
47%
SHRM’s resources on the new health care reform law
54%
50%
Legal counsel (internal or external)
42%
45%
Consultants
30%
30%
Internal experts
17%
8%
Other
12%
0%
10%
January 2011, n = 663
20%
30%
40%
50%
60%
70%
80%
July 2010, n = 759
Note: Percentages do not total 100% as multiple responses were allowed. Respondents were allowed to select their top two options. July 2010 data
are from SHRM Poll: Organizations’ Response to Health Care Reform—Challenges and Actions.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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What resources is your organization currently using in regard to the
health care reform law?
Comparison by Organization Staff Size
•
Insurance broker (by staff size): Smaller organizations (those with fewer than 2,500 employees) were more likely than organizations with
2,500 to 24,999 employees to report that they are currently using insurance brokers as one of their resources in regard to the new law.
Smaller Organizations
•50 to 99 employees (84%)
•100 to 499 employees (83%)
•500 to 2,499 employees (74%)
•
•2,500 to 24,999 employees
(55%)
Differences Based on
Organization Staff Size
Smaller organizations > larger
organizations
SHRM’s resources on the health care reform law (by staff size): Smaller organizations were more likely than organizations with 2,500 to
24,999 employees to report that they are currently using SHRM’s information as one of their resources in regard to the new law.
Smaller Organizations
•50 to 99 employees (62%)
•100 to 499 employees (56%)
•500 to 2,499 employees (52%)
•
Larger Organizations
Larger Organizations
•2,500 to 24,999 employees
(36%)
Differences Based on
Organization Staff Size
Smaller organizations > larger
organizations
Legal counsel (internal or external) (by staff size): Larger organizations (those with 500 or more employees) were more likely than
smaller organizations (100 to 499 employees) to report that they are currently using legal counsel as one of their resources in regard to the
new law.
Smaller Organizations
•100 to 499 employees (38%)
Larger Organizations
•500 to 2,499 employees (54%)
•2,500 to 24,999 employees
(68%)
•25,000 or more employees
(68%)
Differences Based on
Organization Staff Size
Larger organizations > smaller
organizations
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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What resources is your organization currently using in regard to the
health care reform law?
Comparison by Organization Staff Size (continued)
•
Consultants (by staff size): Larger organizations (those with 2,500 to 24,999 employees) were more likely than organizations with 100 to
2,499 employees to report that they are currently using consultants as one of their resources in regard to the new law.
Smaller Organizations
•100 to 499 employees (34%)
•500 to 2,499 employees (42%)
•
Larger Organizations
•2,500 to 24,999 employees
(67%)
Differences Based on
Organization Staff Size
Larger organizations > smaller
organizations
Internal experts (by staff size): Larger organizations (those with 2,500 to 24,999 employees) were more likely than smaller organizations
(100 to 2,499 employees) to report that they are currently using internal experts as one of their resources in regard to the new law.
Smaller Organizations
•100 to 499 employees (23%)
•500 to 2,499 employees (27%)
Larger Organizations
•2,500 to 24,999 employees
(44%)
Differences Based on
Organization Staff Size
Larger organizations > smaller
organizations
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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What resources is your organization currently using in regard to the
health care reform law?
Comparison by Selected Organizational Demographics
Differences Based on
Organization Sector
Differences
Based on
Organization’s
Operations
Location
Differences
Based on
Medical Benefit
Funding
Differences
Based on Union
Status
Insurance broker
U.S.-based only
Privately owned for-profits
organizations (72%)
(80%) & nonprofits (74%) >
Insured (81%) > self- Non-unionized (72%)
> multinational
publicly owned for-profits
insured (59%)
> Unionized (55%)
operations (58%)
(53%) & government (47%)
SHRM’s resources on the new health care reform law
U.S.-based only
Nonprofits (53%) > publicly organizations (52%) Insured (56%) > self- Non-unionized (50%)
owned for-profits (36%)
> multinational
insured (41%)
> Unionized (40%)
operations (37%)
Legal counsel (internal or external)
Publicly owned for-profits
(61%) > privately owned
for-profits (45%)
Consultants
Publicly owned for-profits
(60%) > privately owned
for-profits (33%)
Internal experts
Multinational
operations (57%) > Self-insured (60%) >
U.S.-based only
insured (37%)
organizations (47%)
Multinational
operations (54%) > Self-insured (56%) > Unionized (55%) >
U.S.-based only
insured (30%)
non-unionized (42%)
organizations (41%)
Multinational
operations (38%) > Self-insured (34%) >
U.S.-based only
insured (23%)
organizations (27%)
Note: Blank cell indicates that there were no significant differences in this category.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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If you use an insurance broker or third-party administrator to help you understand the
health care reform law, we would like to understand the primary direction of contacts made
between you and the agent. Please select the option below that best characterizes how this
process has worked for your organization:
The broker or third-party administrator contacts us about as
frequently as we contact them.
35%
The broker or third-party administrator contacts us; we do
reach out to them on occasion, but somewhat less frequently
than they do.
17%
We have not used an insurance broker or third-party
administrator to help us understand the health care reform law.
14%
My organization has been contacting the broker or third-party
administrator on occasion; they do contact us, but somewhat
less frequently than we reach out to them.
13%
The broker or third-party administrator proactively and
frequently contacts us; rarely do we contact them.
13%
My organization has been contacting the broker or third-party
administrator proactively and frequently; rarely do they contact
us.
8%
0%
10%
20%
30%
40%
Note: n = 619
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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If you use an insurance broker or third-party administrator to help you understand the
health care reform law, we would like to understand the primary direction of contacts made
between you and the agent. Please select the option below that best characterizes how this
process has worked for your organization:
Comparison by Organization’s Staff Size, Sector and Medical Benefit Funding
•
The broker or third-party administrator contacts us about as frequently as we contact them (by staff size): Smaller organizations
(those with 500 to 2,499 employees) were more likely than organizations with 2,500 to 24,999 employees to report that the broker or thirdparty administrator and the organization have reached out to each other about equal number of times.
Smaller Organizations
•500 to 2,499 employees (49%)
•
Larger Organizations
•2,500 to 24,999 employees
(29%)
Differences Based on
Organization Staff Size
Smaller organizations > larger
organizations
We have not used an insurance broker or third-party administrator help us understand the health care reform law (by sector):
Publicly owned for-profits (27%) were more likely than privately owned for-profits (7%) to report that their organizations have not used an
insurance broker or third-party administrator to help them understand the health care reform law.
Differences Based on Medical
Benefit Funding
We have not used an insurance broker or third-party administrator to help us understand the
health care reform law
Self-insured (18%) > insured (9%)
The broker or third-party administrator contacts us about as frequently as we contact them
Self-insured (39%) > insured (31%)
The broker or third-party administrator contacts us; we do reach out to them on occasion, but
somewhat less frequently than they do.
Insured (22%) > self-insured (13%)
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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How is your organization’s primary medical benefit currently funded?
Insured, 43%
Self-insured, 57%
Note: n = 660
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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How is your organization’s primary medical benefit currently funded?
Comparison by Organization’s Staff Size, Operations Location, Sector
•
By staff size: Larger organizations (those with 500 or more employees) were more likely than organizations with fewer than 500 employees
to report that their organization’s primary medical benefit is self-insured.
Smaller Organizations
•100 to 499 employees (36%)
Larger Organizations
•500 to 2,499 employees (66%)
•2,500 to 24,999 employees
(82%)
•25,000 or more employees
(86%)
Differences Based on
Organization Staff Size
Larger organizations > smaller
organizations
•
By operations location: Organizations with multinational operations (69%) were more likely than U.S.-based (52%) organizations to report
that their organization’s primary medical benefit is self-insured.
•
By sector: Publicly owned for-profits (70%) were more likely than privately owned for-profits (52%) and nonprofits (49%) to report that their
organization’s primary medical benefit is self-insured.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Demographics: Organization Industry
Industry
Manufacturing—other
17%
Health care, social assistance (e.g., nursing homes, EAP providers)
14%
Government/public administration—federal, state/local, tribal
8%
Services—professional, scientific, technical, legal, engineering
8%
Financial services (e.g., banking)
6%
Educational services/education
6%
Retail/wholesale trade
4%
Construction, mining, oil and gas
4%
Other services (e.g., nonprofit, church/religious organizations)
4%
Note: n = 652
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Demographics: Organization Industry (continued)
Industry
Transportation, warehousing (e.g., distribution)
4%
Insurance
3%
High-tech
3%
Utilities
3%
Manufacturing—auto/auto-related
3%
Services—accommodation, food and drinking places
2%
Telecommunications
2%
Arts, entertainment, recreation
2%
Real estate, rental, leasing
2%
Consulting
1%
Biotech
1%
Publishing, broadcasting, other media
1%
Association—professional/trade
1%
Pharmaceutical
0%
Other
1%
Note: n = 652
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Demographics: Organization Sector
Privately owned for-profit organization
44%
Publicly owned for-profit organization
22%
Nonprofit organization
19%
Government sector
10%
Other
5%
0%
10%
20%
30%
40%
50%
60%
Note: n = 651
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Demographics: Organization Staff Size
50%
40%
30%
30%
29%
27%
20%
10%
9%
6%
0%
50 to 99 employees 100 to 499 employees
500 to 2499
employees
2500 to 24999
employees
25000 or more
employees
Note: n = 580. Percentages do not total 100% due to rounding.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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Demographics: Other
Does organization have U.S.-based
operations (business units) only or
does it operate multinationally?
U.S.-based operations
72%
Multinational operations
28%
Is your organization a single-unit company or a
multi-unit company?
Single-unit company: A company in
which the location and the company
are one and the same.
30%
Multi-unit company: A company that
has more than one location.
70%
Note: n = 657
Note: n = 665
• 20% of organizations indicated that
employees at their work location were
unionized.
Note: n = 650
Are HR policies and practices determined by
the multi-unit corporate headquarters, by each
work location or both?
Multi-unit headquarters determines HR
policies and practices
56%
Each work location determines HR policies
and practices
3%
A combination of both the work location and
the multi-unit headquarters determine HR
policies and practices
41%
Note: n = 480
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011
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SHRM Poll: Health Care Reform – Poll 3
Methodology
•
•
•
•
Response rate = 13%
Sample comprises 698 randomly selected HR
professionals with the job title of manager and above, as
well as HR professionals in the compensation and
benefits functional area. All analyses were based on
respondents working at organizations with a staff size of
50 employees or more.
Margin of error is +/- 4%
Survey fielded December 3 – December 31, 2010
For more poll findings, visit:
www.shrm.org/surveys
Follow us on Twitter:
http://twitter.com/SHRM_Research
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