The Cadillac Tax and Large Employers

Employers have held the line on healthcare cost increases for the third year in a row, reports Mercer in its just-released 2015 National Survey of Employer-Sponsored Health Plans. Nonetheless, 23 percent of large employers are at risk of hitting the Affordable Care Act’s widely despised 40 percent excise tax cost threshold in 2018 — and 45 percent are at risk of hitting it in 2022, according to the report.

Per-employee health benefits costs grew by only 3.8 percent this year, marking the third year in a row of a growth trend of below 4 percent, says Mercer. As in previous years, however, large companies fared better than smaller ones in holding the line: Costs rose by 5.9 percent for organizations with 10 to 499 employees, compared to just 2. 9 percent for those with 500 or more.

Large employers were helped by a jump in enrollment for high-deductible consumer-driven plans, says Mercer, while use of these plans among small employers has grown more slowly. At large companies, enrollment has grown from 15 percent to 28 percent of covered employees within the last three years. At small companies, however, it’s risen from 17 percent to just 19 percent.

Total health benefit costs averaged $11,635 per employee this year, Mercer finds, including employer and employee contributions for medical, dental and other health coverage for employees and their dependents. Employers predict their costs will rise by 4.3 percent on average next year, taking into account changes they expect to make to their health plans to reduce costs. They predict costs will rise by 6.3 percent if they make no changes to their plans.

Mercer credits these cost-containment (some would say “cost-shifting”) strategies with lowering the number of plans expected to be hit by the Cadillac tax in 2018. However, the report notes that a plan’s actuarial value is not the only factor that can drive up costs above the excise tax threshold. Health plan costs can vary significantly by geographic region, the degree of competition among providers in a particular market and workforce demographics, it says. Furthermore, it cautions, due to the way the excise tax threshold is indexed, the number of employers vulnerable to the tax will grow every year that medical inflation exceeds the general CPI — thus, by 2022 45 percent of large employers are estimated to be liable for the tax unless they make changes.