2012 Deloitte Survey of U.S. Employers: Opinions about the U.S. Health Care System and Plans for Employee Health Benefits

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1 2012 Deloitte Survey of U.S. Employers: Opinions about the U.S. Health Care System and Plans for Employee Health Benefits Deloitte Center for Health Solutions & Deloitte Consulting July 2012

2 Executive summary

3 Executive summary: Employer views about the performance of the health care system Employers believe that the U.S. health care system underperforms: 35% of employers grade its performance as an A or a B, while 64% give it a C, D, or F. Grades vary by company position with twice as many Owners/CEO/Presidents (6 in 10) judging system performance as an A or a B than do benefits management executives. Favorable views about system performance center on its clinical capabilities and on medical innovation. C-suite executives see system strengths in access, availability and convenience (74%) compared with executives involved in managing benefits such as Chief Human Resources Officers (48%) and benefits administrators (27%). Unfavorable views center on its wastefulness and high costs. Employers believe that high costs are driven by hospital costs (80%), inefficiencies (68%) and unhealthy lifestyles (67%). Views vary by company position with CFOs and CEOs blaming costs and unhealthy behaviors; HR professionals add in prescription medication costs. Employers believe that investments in primary care have provided higher value compared to others Deloitte Survey of U.S. Employers 3

4 Executive summary: Employer views about the Affordable Care Act (ACA) Employers believe that they have a good understanding of the ACA HR professionals more so than the C-suite. Executives from midsized and larger firms are more likely to feel as if they understand the ACA well. Understanding of delivery system changes in the ACA is low. Familiarity with the individual mandate is the highest (72%). Employer penalties for not offering benefits (66%), essential benefits (53%), and health insurance exchanges (45%) were also familiar to many employers. By contrast, bundled payments, accountable care, etc., are not understood. 30% view the ACA as a good start, 59% a step in the wrong direction. There was a wide range of opinions, from HR who responded more positively to C-suite respondents who think it s a step in the wrong direction. Most employers say their company is not well prepared to implement the 2014 provisions of the ACA. 4 in 10 mid-sized and larger firms feel well-prepared to implement the provisions of the ACA whereas only onefourth of the smallest firms feel this way Deloitte Survey of U.S. Employers 4

5 Executive summary: Employer views about employee health benefits Employers offer health benefits to attract and retain employees and sustain job satisfaction. Most do not intend to drop health benefits coverage. 9% of companies representing 3% of the workforce anticipate dropping coverage in the next 1-3 years, versus 81% of companies representing 84% of the workforce which plan to continue. 10% of companies representing 13% of the workforce are not sure. Prohibitive cost is the driver that may lead employers to consider dropping coverage. To manage health care costs, increased costsharing with employees is considered the optimal strategy. Most say they will increase use of co-pays, deductibles and increased premium participation to reduce costs. Employers believe that health insurance exchanges may be a viable channel for employer benefits strategies. Smaller employers view exchanges more favorably than do bigger companies particular interest is held in exchanges that offer a wide choice of plans and that operate as a non-profit entity. Some employers believe that direct contracting with provider organizations will be a viable cost containment strategy. CEOs and CFOs are more inclined to think direct contracting is favorable compared to HR and benefits staff. Cost, access, and customer service are important factors in direct contracting Deloitte Survey of U.S. Employers 5

6 Executive summary: Employer views about deficit reduction Employers support reforms in medical liability, Medicare and Medicaid, and repeal/ delay of the ACA as means of reducing the federal deficit. Across the board cuts in government spending are considered a higher priority than changes to the health care system Survey respondents were only presented with health care-related alternatives to reduce the deficit Deloitte Survey of U.S. Employers 6

7 Implications Employer-sponsored health benefits are not likely to disappear, but changes that shift financial risk to employees are certain. Therefore, industry and policy-makers should consider the appropriate sets of tools, incentives, and precautions associated with the shift. Employers believe that the government should cut its spending, including entitlement reforms. Therefore, the business community should consider directly engaging in the development of strategies for retirees, populations needing assistance, and relevant policy-making at the state and federal levels. Employers are concerned about health costs; they are unaware of solutions that could improve the safety and quality of care, and simultaneously reduce cost. Companies should consider investing in educating their boards and management about the health care system. The difference between understanding health benefits compliance and optimal ways to extract improved value from the system is a huge gap. Employers do not understand the full scope of the ACA. Policy-makers and industry leaders should consider investing in education about and active improvement of the ACA. Popular areas where employers are directly impacted are better understood than those that are intended to improve the efficiency and quality of the delivery system Deloitte Survey of U.S. Employers 7

8 Context, objectives, and methodology

9 Context Employer-sponsored health insurance covers more than 160 million Americans. 1 According to the Kaiser Family Foundation, 60% of all U.S. firms offered health benefits in Nearly all large firms (99% of firms with 200+ workers) offered employee health benefits, small firms (3-199 workers) were less likely to do so, with 59% offering employee benefits in Average wage growth for employers increased 2.1% in 2011 while average health benefits costs increased 9% over the previous year. 3 Most employers that provide insurance coverage are transferring more financial risk to employees: from defined benefits to defined contribution. Employers might drop coverage if state health insurance exchanges and other elements of the ACA are implemented and effective. Using Deloitte s Health Reform Impact Model, the Center for Health Solutions examined the effects of an employer exit from benefits, as well as three other possible scenarios resulting from the likely impact of the ACA on health insurance coverage. 4 Under the different scenarios, it was estimated that potentially between 23 million and 65 million individuals may join a health insurance exchange by The Kaiser Family Foundation & Health Research Educational Trust. Employer Health Benefits 2011 Annual Survey. Available from: org/?page=abstract&id=2 2. Ibid. 3. Ibid. 4. Deloitte Center for Health Solutions. The impact of health reform on insurance coverage: Projection scenarios over 10 years. Washington D.C. September, centerforhealthsolutions 2012 Deloitte Survey of U.S. Employers 9

10 Objectives This study had two objectives: To explore employers opinions about the ACA To understand employers predisposition toward making changes to their health benefits strategies, including the potential that health exchanges might play a role in their strategy 2012 Deloitte Survey of U.S. Employers 10

11 Methodology Survey sample Respondents Questionnaire Data analytics A web-based survey of 560 randomly selected employers with 50 or more workers offering health benefits; stratified by firm size with systematic controls for industry and location intended to represent the private workforce. Included owners, chief executive officers (CEOs)/presidents, chief financial officers (CFOs), chief human resources officers (CHROs) and individuals responsible for health benefits program decisions. Designated participants were identified through a prescreening telephone call followed by a web-based invitation. A financial incentive or a donation to a charity of their choosing was offered in recognition of their time. The 32-item questionnaire probed opinions about the ACA and anticipated strategies for employee health benefits coverage and cost containment. Areas covered included: current and anticipated changes in employer health benefits, opinions about the performance of the health care system overall, opinions about cost drivers and value for money of health care expenditure, awareness of key features of the ACA, current and likely future employee benefits strategies, understanding and potential responses to health insurance exchanges, and their potential interest in contracting directly with local providers. Two sets of weights were created for the analysis. The first was a firm level weight, calibrated via a ranking method to match firm count distributions in the U.S. Census Bureau s 2009 Statistics of U.S. Businesses by firm size, principal industry, and region. The second was a worker-level weight. The base weight is the product of the firm level weight and its total number of workers nationwide reported by the firm in the survey. The base weight was then calibrated using the raking method described above. This was further adjusted to reflect firms offering health benefits by firm size, region, and industry. All statements in this report reflect the responses of the survey participants only Deloitte Survey of U.S. Employers 11

12 Survey sample Number Health Benefits Offered All respondents All respondents 560 Company Size employees employees 183 1,000-2,499 employees 130 2,500+ employees 139 Industry Mining/Construction 20* Manufacturing 106 Tran/Util/Comm 44 Wholesale 35 Retail 32 Finance 40 Service 187 Health Care 96 Firm Region Northeast 136 Midwest 159 South 183 West 82 Offer health benefits to dependents of employees 95% Currently provide retiree health benefits to any former employees* 15% Offer part-time employees health benefits 26% *3% indicated they offer retiree benefits but don t currently have any retirees Companies where the majority of employees are in plans where coverage is underwritten by an insurer Companies where the majority of employees are in plans that are self-insured 79% 21% Company Role Owner/CEO/President 66 CFO 63 CHRO Chief Human Resources Officer 85 Executive responsible for health benefits programs 177 Office manager or benefits administrator 93 Other 76 *Not sufficient data 2012 Deloitte Survey of U.S. Employers 12

13 Employer views about the performance of the U.S. health care system

14 Most employers believe that the U.S. health care system underperforms Grades vary by company position with 59% of Owners/CEOs/Presidents judging system performance as an A or a B compared with 27% of benefits management executives. Using a typical report card scale with grades of A, B, C, D, and F, with A being excellent and F being failing, how would you grade the overall performance of the U.S. health care system? 100 4% 1% 3% 2% 10% 8% 80 15% 20% 25% 27% 17% 22% 32% 60 40% Percent 47% 40% 37% % 26% 19% 25% 42% 12% 31% 4% 13% 2% 2% 2% 4% 0 Owner/CEO/ President CFO CHRO Benefits Executive Benefits Administrator Other Title of respondent A Excellent B Good C Fair D Poor F Failing 2012 Deloitte Survey of U.S. Employers 14

15 Most employers believe that the U.S. health care system underperforms Grades vary by company position with 59% of Owners/CEOs/Presidents judging system performance as an A or a B compared with 27% of benefits management executives. Using a typical report card scale with grades of A, B, C, D, and F, with A being excellent and F being failing, how would you grade the overall performance of the U.S. health care system? A Excellent B Good C Fair D Poor F Failing Total employers 5% 30% 37% 22% 5% employees 4% 35% 30% 23% 5% employees 6% 24% 43% 20% 5% 1,000-2,499 employees 4% 21% 46% 26% 2% 2,500+ employees 1% 19% 49% 26% 4% Manufacturing 13% 24% 38% 24% 1% Tran/Util/Comm - 35% 19% 40% 6% Wholesale 0% 26% 41% 30% 3% Retail 10% 31% 37% 22% 0% Finance - 31% 42% 20% 6% Service 5% 32% 37% 20% 3% Health Care 6% 29% 42% 13% 6% Northeast 1% 29% 43% 23% 3% Midwest 4% 29% 39% 22% 3% South 8% 35% 33% 20% 3% West 7% 25% 33% 23% 11% Owner, CEO, or President 4% 55% 22% 15% 4% CFO 13% 26% 40% 20% 1% CHRO Chief HR Officer 2% 19% 47% 25% 3% Benefits Executive 2% 25% 40% 27% 2% Benefits Administrator 2% 12% 42% 32% 10% Other 4% 31% 37% 17% 8% 2012 Deloitte Survey of U.S. Employers 15

16 Employers hold favorable views of the health care system s ability to innovate, but costs are a universal concern On a scale of A to F, with A being excellent and F being failing, how would you grade the U.S. health care system on each of the following dimensions? Medical innovation 69% Elements of health care system performance Access to services Ease navigating system Focus on wellness Understand payment, insurance system 14% 23% 29% 53% Costs of care 6% Favorable grade A or B Percent 2012 Deloitte Survey of U.S. Employers 16

17 Employers hold favorable views of the health care system s ability to innovate, but costs are a universal concern On a scale of A to F, with A being excellent and F being failing, how would you grade the U.S. health care system on each of the following dimensions? Favorable grade A or B Medical innovation such as new treatments or services Focusing on wellness rather than illness Access to services, such as availability and convenience Costs of care Ease of navigating the system on behalf of your employees Ease of understanding the insurance and payment system Total employers 69% 23% 53% 6% 29% 14% employees 66% 28% 53% 7% 29% 16% employees 71% 19% 52% 5% 29% 13% 1,000-2,499 employees 68% 12% 53% 3% 21% 7% 2,500+ employees 72% 12% 58% 4% 20% 7% Manufacturing 65% 31% 54% 10% 28% 22% Tran/Util/Comm 58% 20% 38% 9% 14% 0% Wholesale 81% 30% 58% 0% 23% 26% Retail 57% 43% 37% 10% 29% 4% Finance 84% 20% 53% 16% 40% 10% Service 71% 22% 56% 2% 29% 14% Health Care 72% 18% 55% 11% 37% 17% Northeast 61% 21% 47% 1% 23% 20% Midwest 71% 23% 63% 6% 30% 13% South 68% 26% 55% 9% 34% 14% West 75% 22% 41% 5% 25% 11% Owner, CEO, or President 77% 19% 74% 8% 35% 15% CFO 73% 21% 58% 1% 25% 16% CHRO Chief HR Officer 69% 15% 48% 5% 23% 10% Benefits Executive 69% 19% 51% 7% 30% 14% Benefits Administrator 53% 29% 27% 7% 17% 17% Other 69% 34% 49% 9% 38% 11% 2012 Deloitte Survey of U.S. Employers 17

18 Employers believe that costs are driven most by hospital costs, followed by inefficiencies, unhealthy lifestyles, prescription drug costs, insurance company costs, and government regulation (essentially everyone else!) The total costs of the health care system have increased at more than 6% annually in the last few years. Many factors drive those costs. In your view, does each of the following have a MAJOR influence, MINOR influence, or NO INFLUENCE on overall health care system costs? Hospital costs 80% Inefficiencies in the system 68% Unhealthy lifestyles, consumer behavior 67% Prescription drugs 66% Cost Drivers in Health Care System Insurance company costs Government regulation New technologies & equipment Fraud in the system Over-use of testing & surgical procedures Insufficient competition in health insurance market 50% 50% 45% 62% 60% 59% Payments reward volume not performance 45% Defensive medicine Heroic measures to extend life 31% 34% Major influences on health care costs Percent 2012 Deloitte Survey of U.S. Employers 18

19 Views vary by role: CFOs and CEOs blame hospital costs and unhealthy behaviors; HR professionals add prescription drugs and system inefficiencies The total costs of the health care system have increased at more than 6% annually in the last few years. Many factors drive those costs. In your view, does each of the following have a MAJOR influence, MINOR influence, or NO INFLUENCE on overall health care system costs? Factors considered by employers to be a MAJOR influence on overall health care system costs. Prescription drugs Hospital cost Defensive medicine Gov t regulation Insurance company costs Unhealthy lifestyles & consumer behavior Fraud in the system Inefficiencies in the system New technologies and equipment Payment incentives that reward volume instead of performance Over-utilization of testing and surgical procedures Heroic measures to extend life Insufficient competition in the health insurance market Total employers 66% 80% 34% 60% 62% 67% 50% 68% 59% 45% 50% 31% 45% employees 61% 80% 34% 60% 59% 59% 49% 66% 60% 40% 51% 28% 47% employees 71% 81% 34% 61% 65% 76% 52% 70% 57% 49% 47% 35% 43% 1,000-2,499 employees 83% 78% 45% 62% 67% 88% 47% 71% 63% 56% 64% 38% 40% 2,500+ employees 78% 81% 45% 61% 54% 80% 51% 77% 70% 47% 64% 42% 37% Manufacturing 55% 75% 36% 65% 52% 65% 55% 56% 61% 35% 48% 30% 36% Tran/Util/Comm 70% 88% 29% 54% 59% 89% 53% 65% 61% 36% 42% 39% 25% Wholesale 59% 95% 33% 68% 53% 62% 46% 73% 53% 38% 47% 20% 38% Retail 77% 78% 32% 50% 55% 59% 44% 71% 38% 43% 50% 33% 32% Finance 60% 63% 42% 62% 66% 73% 53% 70% 42% 36% 43% 39% 38% Service 62% 80% 34% 57% 64% 64% 50% 63% 62% 48% 53% 32% 56% Health Care 90% 84% 38% 64% 80% 88% 39% 74% 59% 39% 51% 36% 47% Northeast 69% 75% 24% 47% 67% 70% 39% 79% 57% 45% 55% 29% 51% Midwest 69% 85% 43% 64% 67% 74% 46% 64% 60% 51% 58% 33% 39% South 68% 81% 37% 67% 59% 70% 56% 62% 59% 44% 48% 35% 45% West 57% 78% 29% 59% 55% 52% 58% 70% 59% 38% 39% 26% 45% Owner, CEO, or President 57% 75% 45% 77% 48% 65% 50% 55% 66% 46% 47% 38% 41% CFO 57% 80% 30% 57% 58% 60% 39% 70% 55% 36% 52% 29% 51% CHRO Chief HR Officer 71% 91% 41% 51% 68% 72% 48% 75% 68% 55% 61% 35% 42% Benefits Executive 77% 83% 39% 49% 56% 78% 39% 60% 48% 50% 46% 25% 49% Benefits Administrator 72% 77% 25% 59% 79% 61% 60% 75% 55% 44% 46% 22% 47% Other 70% 85% 26% 58% 70% 74% 67% 78% 63% 46% 56% 40% 38% 2012 Deloitte Survey of U.S. Employers 19

20 Employers believe that investments in primary care provide the highest level of value to the health care system Notably, wellness programs and retail clinics were not valued as highly as traditional primary care, and prescription drugs were given a high-value rating above hospitals. On a scale of one to ten, where one indicates low value and ten indicates high value, how much value does each of the following organizations, products or services provide to the overall health care system for every dollar that is spent on them? Primary care 61% Cost Drivers in Health Care System Prescription drugs Hospitals Specialty care Wellness programs Health insurance plans 50% 47% 46% 43% 39% Retail clinics 31% Provides value to health care system (rating of 8, 9, or 10) Percent 2012 Deloitte Survey of U.S. Employers 20

21 Employers believe that investments in primary care provide the highest level of value to the health care system Notably, wellness programs and retail clinics were not valued as highly as traditional primary care, and prescription drugs were given a high-value rating above hospitals. On a scale of one to ten, where one indicates low value and ten indicates high value, how much value does each of the following organizations, products or services provide to the overall health care system for every dollar that is spent on them? Percent responding 8, 9, or 10 on a 10-point scale Hospitals Primary care medicine Specialty care medicine Health insurance plans Prescription drugs Wellness programs Retail clinics Total employers 47% 61% 46% 39% 50% 43% 31% employees 45% 62% 41% 36% 46% 44% 30% employees 50% 59% 50% 43% 54% 41% 33% 1,000-2,499 employees 48% 65% 55% 46% 53% 46% 36% 2,500+ employees 52% 81% 43% 47% 51% 43% 33% Manufacturing 48% 69% 51% 47% 51% 49% 39% Tran/Util/Comm 29% 33% 31% 33% 53% 36% 42% Wholesale 40% 54% 41% 46% 44% 41% 28% Retail 34% 69% 29% 34% 45% 35% 26% Finance 51% 69% 38% 32% 42% 34% 33% Service 48% 59% 44% 44% 56% 39% 34% Health Care 70% 81% 72% 39% 50% 56% 24% Northeast 43% 65% 39% 42% 52% 53% 29% Midwest 46% 65% 53% 40% 49% 42% 33% South 47% 59% 46% 40% 52% 36% 34% West 51% 55% 42% 36% 47% 45% 27% Owner, CEO, or President 40% 64% 48% 44% 41% 44% 27% CFO 41% 59% 36% 39% 49% 48% 28% CHRO Chief HR Officer 56% 69% 52% 55% 67% 34% 36% Benefits Executive 57% 66% 54% 45% 52% 41% 27% Benefits Administrator 50% 52% 39% 36% 48% 30% 41% Other 49% 60% 50% 25% 54% 56% 32% 2012 Deloitte Survey of U.S. Employers 21

22 Employer views about the ACA and health reform

23 Employers surveyed believe that they have a good understanding of the ACA, with HR professionals more confident than CEOs and CFOs How well do you understand the health reform law and its requirements for health insurance coverage for employees? 80 73% 76% 75% 60 58% 60% 50% 52% Percent 40 39% 42% 34% 26% 31% 44% 25% 25% 30% 43% 28% 20 19% 18% 20% 15% employees 8% employees 2% 1,000-2,499 employees 6% 2,500+ employees Owner, CEO, or President CFO 4% CHRO Chief Human Resources Officer 0% Executive Responsible for Health Benefits Program Office Manager or Benefits Administrator Excellent or good understanding Some understanding Limited understanding or don t understand at all Data are rounded 2012 Deloitte Survey of U.S. Employers 23

24 Employers surveyed believe that they have a good understanding of the ACA, with HR professionals more confident than CEOs and CFOs How well do you understand the health reform law and its requirements for health insurance coverage for employees? Excellent Understanding Good Some Limited Don t understand at all Total employers 6% 42% 38% 11% 2% employees 5% 34% 42% 16% 3% employees 6% 52% 34% 5% 2% 1,000-2,499 employees 15% 58% 26% 2% 0% 2,500+ employees 25% 52% 18% 6% 0% Manufacturing 7% 42% 45% 6% 0% Tran/Util/Comm 4% 49% 29% 11% 7% Wholesale 0% 47% 39% 11% 2% Retail 11% 43% 23% 16% 7% Finance 20% 49% 21% 10% 0% Service 3% 43% 41% 10% 3% Health Care 15% 44% 32% 8% 0% Northeast 11% 44% 36% 9% 1% Midwest 8% 41% 38% 9% 3% South 2% 45% 42% 8% 3% West 5% 38% 33% 20% 3% Owner, CEO, or President 6% 44% 31% 16% 4% CFO 4% 48% 44% 4% 0% CHRO Chief HR Officer 4% 56% 25% 10% 5% Benefits Executive 21% 55% 25% 0% 0% Benefits Administrator 3% 26% 43% 21% 7% Other 0% 33% 53% 14% 0% 2012 Deloitte Survey of U.S. Employers 24

25 Employers are most familiar with the individual mandate and employer penalties; less familiar with payment and delivery system reforms On a scale of one to ten, with one being not at all familiar and ten being the most familiar, how familiar are you with the following elements of the health reform law that relate to health insurance? The health reform law includes an individual mandate requiring most people to buy health insurance or pay a penalty 72% The health reform law will include penalties for most employers who do not offer health benefits to their workers 66% Elements of the Affordable Care Act The health reform law requires coverage of essential benefits by most employers offering coverage In the exchanges insurers will be prohibited from refusing to cover patients due to poor health or to charge higher premiums due to the health status of patient(s) The health reform law will set up health insurance exchanges that will offer a choice of health insurance plans to buyers The health reform law attempts to increase research-based information on the comparative effectiveness of different medical treatments 23% 45% 50% 53% The health reform law encourages creation of accountable care organizations and medical homes 22% The health reform law introduces bundled payments/ episode-based payments for hospitals and physicians 20% Familiar (a rating of 8, 9, or 10) Percent 2012 Deloitte Survey of U.S. Employers 25

26 Employers, regardless of size, region, or industry, are more aware of benefits-related ACA elements than delivery system changes On a scale of one to ten, with one being not at all familiar and ten being the most familiar, how familiar are you with the following elements of the health reform law that relate to health insurance? Percent responding 8, 9, or 10 on a 10-point scale The health reform law requires coverage of essential benefits by most employers offering coverage The health reform law includes an individual mandate requiring most people to buy health insurance or pay a penalty The health reform law will set up health insurance exchanges that will offer a choice of health insurance plans to buyers In the exchanges insurers will be prohibited from refusing to cover patients due to poor health or to charge higher premiums due to the health status of patient(s) The health reform law will include penalties for most employers who do not offer health benefits to their workers The health reform law encourages creation of accountable care organizations and medical homes The health reform law attempts to increase researchbased information on the comparative effectiveness of different medical treatments The health reform law introduces bundled payments/episodebased payments for hospitals and physicians Total employers 53% 72% 45% 50% 66% 22% 23% 20% employees 45% 68% 34% 42% 58% 17% 19% 16% employees 61% 74% 57% 59% 75% 27% 28% 25% 1,000-2,499 employees 74% 81% 72% 68% 83% 30% 25% 24% 2,500+ employees 81% 80% 73% 67% 81% 40% 35% 33% Manufacturing 61% 76% 53% 61% 76% 19% 40% 12% Tran/Util/Comm 33% 71% 32% 41% 62% 14% 9% 13% Wholesale 53% 63% 41% 41% 52% 9% 24% 15% Retail 61% 74% 29% 45% 67% 20% 17% 25% Finance 45% 74% 49% 45% 58% 25% 27% 22% Service 51% 69% 43% 47% 66% 16% 16% 11% Health Care 66% 80% 53% 61% 69% 55% 31% 58% Northeast 59% 65% 44% 48% 67% 19% 26% 19% Midwest 50% 73% 49% 54% 64% 23% 24% 19% South 52% 76% 42% 47% 64% 24% 24% 22% West 53% 69% 46% 54% 72% 21% 19% 20% Owner, CEO, or President 48% 73% 41% 56% 58% 25% 23% 23% CFO 51% 75% 48% 58% 74% 21% 18% 12% CHRO Chief HR Officer 52% 67% 62% 52% 68% 24% 23% 22% Benefits Executive 72% 80% 59% 68% 80% 33% 34% 26% Benefits Administrator 55% 58% 35% 32% 53% 15% 27% 16% Other 45% 73% 36% 35% 68% 17% 18% 25% 2012 Deloitte Survey of U.S. Employers 26

27 The majority of employers who responded view the ACA as a step in the wrong direction Benefits Executives (41%) and Chief HR Officers (38%) feel reform is a good start compared with Owners/CEOs/Presidents (21%). 54% of employers in the health care industry view the ACA favorably; less than 1% of retail firms see the ACA as a good start. Based on what you know or have heard about the health reform law, is it a good start or a step in the wrong direction? Owner/CEO/President 21% 72% 7% CFO 32% 64% 3% CHRO 38% 45% 17% Position in Company Benefits Executive Benefits Administrator 31% 41% 50% 54% 19% 5% Other 26% 55% 19% All Respondents 30% 59% 11% Percent A good start A step in the wrong direction Don't know/no opinion Due to rounding, some totals are not exactly 100% Deloitte Survey of U.S. Employers 27

28 The majority of employers who responded view the ACA as a step in the wrong direction Benefits Executives (41%) and Chief HR Officers (38%) feel reform is a good start compared with Owners/CEOs/Presidents (21%). 54% of employers in the health care industry view the ACA favorably; less than 1% of retail firms see the ACA as a good start. Based on what you know or have heard about the health reform law, is it a good start or a step in the wrong direction? A good start A step in the wrong direction Don t know/ no opinion Total employers 30% 59% 11% employees 25% 66% 9% employees 37% 50% 14% 1,000-2,499 employees 39% 54% 7% 2,500+ employees 35% 57% 8% Manufacturing 21% 69% 9% Tran/Util/Comm 17% 82% 1% Wholesale 8% 74% 18% Retail 1% 87% 13% Finance 32% 56% 12% Service 37% 50% 13% Health Care 54% 43% 3% Northeast 43% 51% 6% Midwest 33% 51% 17% South 24% 70% 6% West 25% 59% 16% Owner, CEO, or President 21% 72% 7% CFO 32% 64% 3% CHRO Chief HR Officer 38% 45% 17% Benefits Executive 41% 54% 5% Benefits Administrator 31% 50% 19% Other 26% 55% 19% Due to rounding, some totals are not exactly 100% Deloitte Survey of U.S. Employers 28

29 Smaller employers report being less prepared to implement provisions of the ACA On a scale of one to ten, with one being not at all prepared and ten being fully prepared, how well-prepared is your company to implement or respond to the 2014 provisions of health reform law? % 26% 18% 5% 10% 80 57% 51% Percent 60 50% 50% 50% % 24% 32% 38% 39% 0 Total employers employees employees 1,000-2,499 employees 2,500+ employees Prepared (Rating of 8, 9, or 10) Somewhat Prepared (Rating of 4, 5, 6, or 7) Not prepared (Rating of 1, 2, or 3) 2012 Deloitte Survey of U.S. Employers 29

30 Smaller employers report being less prepared to implement provisions of the ACA On a scale of one to ten, with one being not at all prepared and ten being fully prepared, how well-prepared is your company to implement or respond to the 2014 provisions of health reform law? Prepared (Rating of 8, 9, or 10) Somewhat prepared (Rating of 4, 5, 6, or 7) Not prepared (Rating of 1, 2, or 3) Total employers 28% 50% 22% employees 24% 50% 26% employees 32% 50% 18% 1,000-2,499 employees 38% 57% 5% 2,500+ employees 39% 51% 10% Manufacturing 24% 47% 29% Tran/Util/Comm 41% 36% 23% Wholesale 28% 48% 24% Retail 12% 53% 35% Finance 33% 45% 22% Service 25% 51% 24% Health Care 28% 64% 8% Northeast 27% 61% 12% Midwest 35% 43% 22% South 27% 48% 25% West 22% 51% 27% Owner, CEO, or President 21% 53% 26% CFO 30% 49% 21% CHRO Chief HR Officer 30% 45% 25% Benefits Executive 50% 45% 5% Benefits Administrator 25% 56% 19% Other 18% 48% 34% 2012 Deloitte Survey of U.S. Employers 30

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