1. SHRM Poll:
Health Care Reform: Where Are Organizations
in the Decision-Making Process?
February 7, 2011

2. Health Care Reform Series: Poll 3
Introduction
Landmark legislation that brought about major reforms in health care coverage in the
United States was enacted in March 2010. The law affects employers and HR
professionals in a variety of ways. SHRM will be conducting a series of polls on health
care reform and its implications for employers and employees. This presentation covers
the findings from the third poll in this series, which was conducted in December 2010.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 2

3. Key Findings
• Will Organizations Drop Health Care Coverage? One-half of organizations (51%) have decided
not to drop health care coverage for employees as a result of the health care reform law. Of these
organizations, 24% made this decision without conducting an analysis to determine whether to
continue offering health care coverage or to drop coverage and pay opt-out fines. Twenty-seven
percent did conduct such analysis and decided not to drop coverage. Nearly one-third of
organizations (27%) are still conducting or plan to conduct an analysis on the impact of health care
reform.
• Many Organizations Waiting on Regulatory Guidance. Nearly one-half of organizations (48%)
indicated that they are waiting on regulatory guidance or information on specific provisions in the
health care reform law to make some health care decisions for their organizations.
• What Are the Implementation Barriers? For a number of provisions in the health care law that will
take effect between 2011 and 2018, 27% to 65% of organizations reported that there are no
implementation barriers for their organizations. Of the organizations that reported implementation
barriers, 54% reported the cost of including benefits for adult children up to age 26 (2011) as an
implementation barrier. In addition, one-third (34%) of organizations reported employee out-of-
pocket expenses as an implementation barrier to their organization putting into action the exclusion
on purchasing over-the counter medications using flexible spending account (2011).
• HR Knowledge About Law’s Specifics Steadily Increasing. The percentage of HR professionals
who are comfortable with their level of familiarity with the health care reform law increased from
48% in July 2010 to 62% in January 2011.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 3

4. Is your organization engaging in an analysis to determine the impact of
the health care reform law on your health care plan?
Will not conduct an analysis and already decided we will 24%
not drop health care coverage 34%
Already conducted an analysis and decided not to drop 27%
health care coverage 12%
Plan to conduct such an analysis 17%
15%
Currently conducting analysis 10%
22%
Already conducted an analysis and decided to drop health <1%
care coverage <1%
Will not conduct an analysis and already decided to drop <1%
health care coverage <1%
Unsure at this time 22%
16%
0% 10% 20% 30% 40%
January 2011, n = 677 June 2010, n = 813
• One-half of organizations (51%) have decided not to drop health care coverage for
employees as a result of the health care reform law compared with 46% in June 2010.
Note: Percentages do not total 100% due to rounding. June 2010 data are from SHRM Poll: Organizations’ Response to Health Care Reform.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 4

5. Is your organization engaging in an analysis to determine the impact of
the new health care reform law on your health care plan?
Comparison by Medical Benefit Funding
Differences Based on Medical
Benefit Funding
Self-insured (33%) > insured
Already conducted an analysis and decided not to drop health care coverage
(20%)
Will not conduct an analysis and already decided we will not drop health care coverage Insured (31%) > self-insured (18%)
Unsure at this time Insured (26%) > self-insured (18%)
Organizations with self-insured plans were more likely to have already conducted analysis and decided NOT to drop
health care coverage.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 5

6. Is your organization waiting to make any health care plan decisions
based on any of the following factors?
Yes No Don’t know
Regulatory guidance or information on specific provisions in the health care reform law 48% 42% 10%
Changes to specific provisions in the health care reform law 32% 57% 11%
Repeal of specific provisions of the health care reform law 24% 64% 12%
Repeal of the entire health care reform law 13% 75% 12%
Other factors 13% 53% 35%
Note: n = 617-674. Percentages do not total 100% due to rounding. Data sorted by “Yes” column.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 6

7. Is your organization waiting to make any health care plan decisions
based on any of the following factors?
Comparison by Medical Benefit Funding
Differences Based on Medical
Benefit Funding
Self-insured (54%) > insured
Regulatory guidance or information on specific provisions in the health care reform law
(42%)
Self-insured (36%) > insured
Changes to specific provisions in the health care reform law
(28%)
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 7

8. For the following provisions of the health care reform law, what do you
see as the main implementation barrier in your organization?
implementation
implementation
understanding
barrier for my
out-of pocket
of the details
Management
organization
organization
employees,
There is no
support by
Employee
of the law
provision
unions or
Lack of
Lack of
Cost of
to the
Other
cost
Limits on deductibles in the small group market (companies with less
than 100 employees) to $2,000 for individuals and $4,000 for families 65% 8% 18% 3% 2% 4%
(2014)
Prohibition on lifetime dollar limits on coverage of essential benefits
52% 8% 32% 4% 1% 4%
(2011)
Exclusion on purchasing over-the counter medications using flexible
43% 13% 1% 34% 8% 2%
spending account (2011)
Inclusion of benefits for adult children up to age 26 (2011) 37% 4% 54% 2% 1% 2%
Employer mandate to provide coverage or pay a penalty (2014) 37% 17% 37% 1% 4% 4%
Excise tax on high-value (so-called "Cadillac") health plans (2018) 34% 19% 28% 7% 8% 4%
Requirement to report the value of an employee's health benefits on
30% 17% 38% 2% 6% 7%
individual employee W-2s (W-2s for 2012 tax year)
Tax form 1099 requirement for all vendor transactions above $600
29% 22% 39% 0% 2% 7%
(2012)
CLASS Act (government-provided long-term care insurance) (2011-
27% 48% 12% 3% 3% 6%
2013)
Note: n = 674-698. Percentages do not total 100% due to rounding. Data sorted by first column.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 8

9. What is your level of agreement with the following statement:
"I am comfortable with what I know about the new health care reform law."
60%
54%
50%
45%
41%
40%
32%
30%
20%
11%
10% 8%
6%
3%
0%
Strongly disagree Disagree Agree Strongly agree
July 2010, n = 774 January 2011, n = 679
• The percentage of HR professionals who are comfortable with their level of knowledge about the
health care reform law increased from 48% in July 2010 to 62% in December 2010. This shows that more
HR professionals are quickly familiarizing themselves with the health care reform law, thereby helping their
organizations with the implementation of the law.
Note: July 2010 data are from SHRM Poll: Organizations’ Response to Health Care Reform—Challenges and Actions.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 9

10. What is your level of agreement with the following statement:
"I am comfortable with my level of knowledge about the CLASS Act provision
(government-run long-term care insurance) in the health care reform law."
60% 58%
50%
40%
30% 28%
20%
12%
10%
2%
0%
Strongly disagree Disagree Agree Strongly agree
• Only 14% of HR professionals are comfortable with what they know about the CLASS Act provision. Nearly
half of organizations (48%) indicated that lack of understanding of the details of the CLASS Act provision as an
implementation barrier to their organizations.
Note: n = 678 Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 10

11. What resources is your organization currently using in regard to the
health care reform law?
Insurance broker 69%
73%
SHRM’s resources on the new health care reform law
47%
54%
Legal counsel (internal or external)
50%
42%
Consultants
45%
30%
Internal experts
30%
17%
Other
8%
12%
0% 10% 20% 30% 40% 50% 60% 70% 80%
January 2011, n = 663 July 2010, n = 759
Note: Percentages do not total 100% as multiple responses were allowed. Respondents were allowed to select their top two options. July 2010 data
are from SHRM Poll: Organizations’ Response to Health Care Reform—Challenges and Actions.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 11

12. What resources is your organization currently using in regard to the
health care reform law?
Comparison by Organization Staff Size
• Insurance broker (by staff size): Smaller organizations (those with fewer than 2,500 employees) were more likely than organizations with
2,500 to 24,999 employees to report that they are currently using insurance brokers as one of their resources in regard to the new law.
Smaller Organizations Larger Organizations Differences Based on
Organization Staff Size
•50 to 99 employees (84%) •2,500 to 24,999 employees Smaller organizations > larger
•100 to 499 employees (83%) (55%) organizations
•500 to 2,499 employees (74%)
• SHRM’s resources on the health care reform law (by staff size): Smaller organizations were more likely than organizations with 2,500 to
24,999 employees to report that they are currently using SHRM’s information as one of their resources in regard to the new law.
Smaller Organizations Larger Organizations Differences Based on
Organization Staff Size
•50 to 99 employees (62%) •2,500 to 24,999 employees Smaller organizations > larger
•100 to 499 employees (56%) (36%) organizations
•500 to 2,499 employees (52%)
• Legal counsel (internal or external) (by staff size): Larger organizations (those with 500 or more employees) were more likely than
smaller organizations (100 to 499 employees) to report that they are currently using legal counsel as one of their resources in regard to the
new law.
Smaller Organizations Larger Organizations Differences Based on
Organization Staff Size
•100 to 499 employees (38%) •500 to 2,499 employees (54%) Larger organizations > smaller
•2,500 to 24,999 employees organizations
(68%)
•25,000 or more employees
(68%)
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 12

13. What resources is your organization currently using in regard to the
health care reform law?
Comparison by Organization Staff Size (continued)
• Consultants (by staff size): Larger organizations (those with 2,500 to 24,999 employees) were more likely than organizations with 100 to
2,499 employees to report that they are currently using consultants as one of their resources in regard to the new law.
Smaller Organizations Larger Organizations Differences Based on
Organization Staff Size
•100 to 499 employees (34%) •2,500 to 24,999 employees Larger organizations > smaller
•500 to 2,499 employees (42%) (67%) organizations
• Internal experts (by staff size): Larger organizations (those with 2,500 to 24,999 employees) were more likely than smaller organizations
(100 to 2,499 employees) to report that they are currently using internal experts as one of their resources in regard to the new law.
Smaller Organizations Larger Organizations Differences Based on
Organization Staff Size
•100 to 499 employees (23%) •2,500 to 24,999 employees Larger organizations > smaller
•500 to 2,499 employees (27%) (44%) organizations
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 13

14. What resources is your organization currently using in regard to the
health care reform law?
Comparison by Selected Organizational Demographics
Differences Based on Differences Differences Differences
Organization Sector Based on Based on Based on Union
Organization’s Medical Benefit Status
Operations Funding
Location
U.S.-based only
Privately owned for-profits
organizations (72%)
(80%) & nonprofits (74%) > Insured (81%) > self- Non-unionized (72%)
Insurance broker > multinational
publicly owned for-profits insured (59%) > Unionized (55%)
operations (58%)
(53%) & government (47%)
U.S.-based only
Nonprofits (53%) > publicly organizations (52%) Insured (56%) > self- Non-unionized (50%)
SHRM’s resources on the new health care reform law
owned for-profits (36%) > multinational insured (41%) > Unionized (40%)
operations (37%)
Multinational
Publicly owned for-profits
operations (57%) > Self-insured (60%) >
Legal counsel (internal or external) (61%) > privately owned
U.S.-based only insured (37%)
for-profits (45%)
organizations (47%)
Multinational
Publicly owned for-profits
operations (54%) > Self-insured (56%) > Unionized (55%) >
Consultants (60%) > privately owned
U.S.-based only insured (30%) non-unionized (42%)
for-profits (33%)
organizations (41%)
Multinational
operations (38%) > Self-insured (34%) >
Internal experts
U.S.-based only insured (23%)
organizations (27%)
Note: Blank cell indicates that there were no significant differences in this category.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 14

15. If you use an insurance broker or third-party administrator to help you understand the
health care reform law, we would like to understand the primary direction of contacts made
between you and the agent. Please select the option below that best characterizes how this
process has worked for your organization:
The broker or third-party administrator contacts us about as
frequently as we contact them.
35%
The broker or third-party administrator contacts us; we do
reach out to them on occasion, but somewhat less frequently 17%
than they do.
We have not used an insurance broker or third-party
administrator to help us understand the health care reform law.
14%
My organization has been contacting the broker or third-party
administrator on occasion; they do contact us, but somewhat 13%
less frequently than we reach out to them.
The broker or third-party administrator proactively and
frequently contacts us; rarely do we contact them.
13%
My organization has been contacting the broker or third-party
administrator proactively and frequently; rarely do they contact 8%
us.
0% 10% 20% 30% 40%
Note: n = 619
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 15

16. If you use an insurance broker or third-party administrator to help you understand the
health care reform law, we would like to understand the primary direction of contacts made
between you and the agent. Please select the option below that best characterizes how this
process has worked for your organization:
Comparison by Organization’s Staff Size, Sector and Medical Benefit Funding
• The broker or third-party administrator contacts us about as frequently as we contact them (by staff size): Smaller organizations
(those with 500 to 2,499 employees) were more likely than organizations with 2,500 to 24,999 employees to report that the broker or third-
party administrator and the organization have reached out to each other about equal number of times.
Smaller Organizations Larger Organizations Differences Based on
Organization Staff Size
•500 to 2,499 employees (49%) •2,500 to 24,999 employees Smaller organizations > larger
(29%) organizations
• We have not used an insurance broker or third-party administrator help us understand the health care reform law (by sector):
Publicly owned for-profits (27%) were more likely than privately owned for-profits (7%) to report that their organizations have not used an
insurance broker or third-party administrator to help them understand the health care reform law.
Differences Based on Medical
Benefit Funding
We have not used an insurance broker or third-party administrator to help us understand the
Self-insured (18%) > insured (9%)
health care reform law
The broker or third-party administrator contacts us about as frequently as we contact them Self-insured (39%) > insured (31%)
The broker or third-party administrator contacts us; we do reach out to them on occasion, but
Insured (22%) > self-insured (13%)
somewhat less frequently than they do.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 16

17. How is your organization’s primary medical benefit currently funded?
Insured, 43%
Self-insured, 57%
Note: n = 660 Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 17

18. How is your organization’s primary medical benefit currently funded?
Comparison by Organization’s Staff Size, Operations Location, Sector
• By staff size: Larger organizations (those with 500 or more employees) were more likely than organizations with fewer than 500 employees
to report that their organization’s primary medical benefit is self-insured.
Smaller Organizations Larger Organizations Differences Based on
Organization Staff Size
•100 to 499 employees (36%) •500 to 2,499 employees (66%) Larger organizations > smaller
•2,500 to 24,999 employees organizations
(82%)
•25,000 or more employees
(86%)
• By operations location: Organizations with multinational operations (69%) were more likely than U.S.-based (52%) organizations to report
that their organization’s primary medical benefit is self-insured.
• By sector: Publicly owned for-profits (70%) were more likely than privately owned for-profits (52%) and nonprofits (49%) to report that their
organization’s primary medical benefit is self-insured.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 18

19. Demographics: Organization Industry
Industry
Manufacturing—other 17%
Health care, social assistance (e.g., nursing homes, EAP providers) 14%
Government/public administration—federal, state/local, tribal 8%
Services—professional, scientific, technical, legal, engineering 8%
Financial services (e.g., banking) 6%
Educational services/education 6%
Retail/wholesale trade 4%
Construction, mining, oil and gas 4%
Other services (e.g., nonprofit, church/religious organizations) 4%
Note: n = 652
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 19

20. Demographics: Organization Industry (continued)
Industry
Transportation, warehousing (e.g., distribution) 4%
Insurance 3%
High-tech 3%
Utilities 3%
Manufacturing—auto/auto-related 3%
Services—accommodation, food and drinking places 2%
Telecommunications 2%
Arts, entertainment, recreation 2%
Real estate, rental, leasing 2%
Consulting 1%
Biotech 1%
Publishing, broadcasting, other media 1%
Association—professional/trade 1%
Pharmaceutical 0%
Other 1%
Note: n = 652
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 20

21. Demographics: Organization Sector
Privately owned for-profit organization 44%
Publicly owned for-profit organization 22%
Nonprofit organization 19%
Government sector 10%
Other 5%
0% 10% 20% 30% 40% 50% 60%
Note: n = 651
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 21

22. Demographics: Organization Staff Size
50%
40%
30% 29%
30% 27%
20%
9%
10%
6%
0%
50 to 99 employees 100 to 499 employees 500 to 2499 2500 to 24999 25000 or more
employees employees employees
Note: n = 580. Percentages do not total 100% due to rounding.
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 22

23. Demographics: Other
Does organization have U.S.-based Is your organization a single-unit company or a
operations (business units) only or multi-unit company?
does it operate multinationally?
Single-unit company: A company in 30%
U.S.-based operations 72% which the location and the company
are one and the same.
Multinational operations 28%
Multi-unit company: A company that 70%
has more than one location.
Note: n = 657
Note: n = 665
• 20% of organizations indicated that Are HR policies and practices determined by
employees at their work location were the multi-unit corporate headquarters, by each
unionized. work location or both?
Note: n = 650 Multi-unit headquarters determines HR 56%
policies and practices
Each work location determines HR policies 3%
and practices
A combination of both the work location and 41%
the multi-unit headquarters determine HR
policies and practices
Note: n = 480
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 23

24. SHRM Poll: Health Care Reform – Poll 3
Methodology
• Response rate = 13%
• Sample comprises 698 randomly selected HR
professionals with the job title of manager and above, as
well as HR professionals in the compensation and
benefits functional area. All analyses were based on
respondents working at organizations with a staff size of
50 employees or more.
• Margin of error is +/- 4%
• Survey fielded December 3 – December 31, 2010
For more poll findings, visit:
www.shrm.org/surveys
Follow us on Twitter:
http://twitter.com/SHRM_Research
Health Care Reform - Where Are Organizations in the Decision-Making Process | ©SHRM 2011 24