Dr. Jim Spears speaks with Sarah Ittner, a New York-based actor who does not have health coverage, at the Actors Fund's Al Hirschfeld Free Health Clinic on March 23, 2011 in New York City.

Tess Vigeland: It's been more than a year since the big health care reform law passed. And we're still asking: What will it mean? Especially for those who have insurance through their employers.

Well a new report out from McKinsey & Co. found it may mean a whole lot of us won't be offered insurance at our jobs anymore. Thirty percent of employers said they probably would stop offering workers health insurance after 2014. That's when the bulk of the law takes effect, including the option of state-run insurance exchanges.

From our health desk at WHYY in Philadelphia, Gregory Warner reports.


Gregory Warner: If it were just a question of the bottom line, Mark Kallenback would drop coverage for his workers in a heartbeat. He runs a housing management company in Portland, Ore. He's got 350 employees. In 2014, he figures he could send those workers to buy their own coverage through Oregon's new insurance exchange. He'd pay a $2000 penalty per worker and still have lots of cash left over.

Mark Kallenback: Would we do it if it wasn't in our employees' interest and only in our own? That would be a very, very tough decision.

Because Kallenback has grown up in a world where employers have to offer health plans to attract the best workers. Bob Atlas of Avalere Health says that calculus could shift.

Bob Atlas: Employers of low wage workers who already don't offer generous benefits might start to move first.

This could create a cascade effect: with more businesses offering to raise wages while sending employees to the exchanges for coverage.

Atlas: In fact, some folks say the exchanges will offer more choice than what an employer can offer. Premiums might actually go down.

The research firm McKinsey found that 30 percent of employers may drop coverage after 2014. But other analysts say that employer coverage will stay flat or increase. Steve King of Emergent Research says that employer behavior is so hard to predict, in part because no one knows if the exchanges will work.

Steve King: Most employers are not going to want to send their employees into lousy health care coverage.

Which brings us back to Kallenback, the Oregon businessowner we heard from up top. He'd be happy to stop paying the costs of health care, just so long as his employees don't stop wanting to work for him.

In Philadelphia, I'm Gregory Warner for Marketplace.

About the author

Gregory Warner is a senior reporter covering the economics and business of healthcare for the entire Marketplace portfolio.

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