The impact of the Affordable Care Act (ACA) on employee absence and disability is slowly emerging. With less than two years of experience, we are still facing a changing environment and differing interpretations of impact. Some issues are surfacing that could adversely affect employee absence and productivity.
The ACA brought new health insurance coverage to about 16.4 million people.1 About 150 million more still have coverage through employer-sponsored plans, including “private exchanges.” Employers’ use of private exchanges doubled from 2014 to 2015, with projections of up to 40 million employee participants by 2018.2
Since the ACA, the level of cost sharing has increased for many employees and their families; in 2015, maximums are $6,600 deductible and $13,200 annual out-of-pocket.3 The number of consumer directed health plans (CDHPs) offered is growing, further increasing cost-sharing trends.
Employees’ share of costs is well above historical levels. As a result, a sudden medical emergency or the annual cost of treatment or drugs for individuals who have multiple chronic health conditions can overwhelm the budgets of many, not just those with lower incomes. Cost sharing is meant to lead employees to make better choices in usage and cost of care. However, some data suggests that increased costs may lead some consumers to avoid beneficial care.
A recent study by the Integrated Benefits Institute found that under CDHP, consumers are more likely to forgo treatment and have medication compliance issues-particularly for asthma, cardiovascular disease, and diabetes.4 Poor treatment adherence contributes to increased absence and disability and poorer long-term health outcomes.
On the positive side, employers can offer telemedicine, retail, and worksite clinic delivery options to reinforce positive health behaviors. These options offer lower cost than a traditional primary care physician visit with greater convenience, increasing employee access to medical advice.
Employers have flexibility to manage plan design, including when choosing private exchanges, as long as ACA minimum standards are met. As an example, the ACA mandates free screening for diabetes, high blood pressure, and depression but doesn’t require cost assistance on treatment or preventive drugs. Given the impact of nontreatment of these chronic diseases, some employers use low co-pays or low pharmacy deductibles for drugs to enable or reinforce adherence to treatment.
Employers can leverage employee desire for low cost and convenience by identifying in-network retail clinics and telemedicine providers that provide electronic interfaces with the primary care physician. This can increase the number of lower-cost health touch points, while still linking treatment information for more comprehensive healthcare oversight.
In this time of rapid changes in healthcare delivery, disability management professionals must understand the opportunities and risks in our changing environment so they can continue to align healthcare strategy decisions with improved productivity and employee health.
1. CNN. (2015). http://www.cnn.com/2015/03/16/politics/obamacare-numbers-16-million-insured-rate/
2. Accenture. Insight Private Health Insurance Exchange Annual Enrollment. https://www.accenture.com/us-en/insightprivate-health-insurance-exchange-annual-enrollment
3. Politz K. (2015). Medical Debt Among Insured Consumers: The Role of Cost Sharing, Transparency, and Consumer Assistance. Washington, DC: Kaiser Family Foundation. http://kff.org/health-costs/perspective/medical-debt-among-insured-consumers-the-role-of-costsharing-transparency-and-consumer-assistance/
4. Gifford B. (2014). Consumer Directed Health Plans: the Challenge to Managing Workforce Health, Performance and Productivity. San Francisco: Integrated Benefits Institute.