The next health care overhaul? Look to employers

(04-24) 00:00 PDT WASHINGTON (AP) --

If the Supreme Court strikes down President Barack Obama's health care law, employers and insurance companies not the government will be the main drivers of change over the next decade and maybe even longer.

They'll borrow some ideas from Obamacare, and push harder to cut costs.

Business can't and won't take care of America's 50 million uninsured, but for the majority with coverage, 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 workplace insurance will lose ground to high-deductible plans with tax-free accounts for routine medical expenses, to which employers can contribute.

_ Increasingly, 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 may 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 adult 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 to insurers and employers that they deliver quality care. These networks of medical providers would earn part of their fees for keeping patients as healthy as possible, similar to the "accountable care organizations" in the health care law.

_ Some workers will pick their health plans from a private insurance exchange, another similarity to Obama's law. They'll get fixed payments from their employers to choose from four levels of coverage: platinum, gold, silver and bronze. Those who pick rich benefits would pay more. It's an approach that Rep. Paul Ryan, R-Wis., the GOP budget leader, also wants to try with Medicare.

"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. We still have a major problem in this country with very expensive health care."

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The next health care overhaul? Look to employers

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