Obamacare fall would put employers at helm

WASHINGTON -- If the Supreme Court strikes down President Barack Obama's health care overhaul, don't look to government for what comes next.

Employers and insurance companies will take charge. They'll borrow some ideas from Obamacare, ditch others, and push even harder to cut costs. Here's what experts say to expect:

Workers will bear more of their own medical costs as job coverage shifts to plans with higher deductibles, the amount you pay out of pocket each year before insurance kicks in. Traditional insurance will lose ground to high-deductible plans with tax-free accounts for routine expenses, to which employers can contribute.

Smokers will face financial penalties if they don't at least seriously try to quit. Employees with a weight problem and high cholesterol are next. They'll get tagged as health risks and nudged into diet programs.

Some companies will keep the health care law's most popular benefit so far, coverage for children until they turn 26. Others will cut it to save money.

Workers and family members will be steered to hospitals and doctors that can prove they deliver quality care. These medical providers would earn part of their fees for keeping patients as healthy as possible.

Some workers will pick their health plans from a private insurance exchange, another similarity to Obama's law. They'll get fixed payments from employers to choose from four levels of coverage: platinum, gold, silver and bronze. Those picking rich benefits would pay more.

"Employers had been the major force driving health care change in this country up until the passage of health reform," said Tom Billet, a senior benefits consultant with Towers Watson, which advises major companies. "If Obamacare disappears . . . we go back to square one. "

Starting in 2014, the law requires most Americans to obtain health insurance, through an employer or a government program or by buying their own policies. In return, insurance companies would be prohibited from turning away the sick. Government would subsidize premiums for millions now uninsured.

If the law is invalidated, that would leave it to employers, who cover about three out of five Americans under age 65.

"With or without health care reform, employers are committed to offering health care benefits and want to manage costs," said Tracy Watts, a senior consultant with Mercer, which advises many large employers. "The health care reform law itself has driven employers, as well as the provider community, to advance some bolder strategies for cost containment."

First, employers would push harder to control their own costs by shifting more financial responsibility to workers. Data from Mercer's employer survey suggests that a typical large employer can save nearly $1,800 per worker by replacing traditional preferred provider plans with a high-deductible policy combined with a health care account.