As private company CEOs review the provisions of the federal Patient Protection and Affordable Care Act (the "Act"), nearly half (47 percent) of executives surveyed for PwC’s Private Company Trendsetter Barometer say the Act may have a notable financial impact on their business. However, nearly one-third (31%) of respondents believe it’s “too soon to tell” how the Act’s provisions will impact their companies. Twenty percent don't anticipate a notable financial impact; 2% were unreported. Companies that don't anticipate a notable financial impact are forecasting above-average revenue growth, compared with the other companies surveyed.

Although the majority of Trendsetter CEOs (70%) have begun reviewing their healthcare benefit plans in light of the Act, 55% have not yet determined what changes need to be made to their companies’ plans. Only 15% have started to take action.

“In helping our clients assess the effect that healthcare reform will have on their organizations, we've been looking at their overall healthcare benefit packages to evaluate whether they're in compliance with the Act, as well as considering strategies for managing the expected increase in healthcare costs," says Ken Esch, a partner in PwC's Private Company Services practice. "In light of current economic conditions, it's imperative that companies begin assessing their healthcare plans and cost-containment strategies soon rather than later.”

Overall impact unclear
When asked which of the Act's provisions were likely to have a moderate or significant overall impact on their company (including an impact on costs, benefits, strategy, operations, systems, employee recruitment, wellness programs, etc.), Trendsetter CEOs' responses varied a good deal. "Although we're seeing CEOs begin to review their options and healthcare strategy, on the whole they’re uncertain about how significant an impact the provisions will have on their organization,” says Esch.

This is evident, for instance, in the Trendsetter CEOs' response to the Act's tax provisions. Although a fair number of private companies expect the tax provisions (starting in 2013) to have a moderate to significant effect on their business (31% say this about the Medicare tax increase and 26% about the net investment income tax), the overall response to those provisions was mixed.

“This is an interesting time for Trendsetter CEOs, when you consider they'll be implementing new healthcare requirements in tandem with increasing tax rates," says Esch. "It's possible this could create a cash flow issue as CEOs look to continue reinvesting in their business. Every company is different, of course, but we’re seeing clients consider accelerating income or deferring deductions now at the lower tax rate, which should provide a permanent tax benefit when rates go up.”

Table 1: Significant Overall Impact on Business

                                                              Moderate or              
                                                               Significant           Slight                 No                 Not certain/            
First Plan Year Provisions                     Impact             Impact             Impact            Not reported          

  • No "pre-existing condition"
    exclusions for children or others..... 28%................. 25%................. 26%...................... 21%
  • Coverage of dependents
    until age 26........................................ 21%................. 22%................. 29%...................... 28%
  • Removal of lifetime
    limits on benefits................................ 21%................. 20%................. 32%...................... 27%
  • Elimination of "unreasonable"
    annual limits on benefits................... 15%................. 19%................. 38%...................... 28%

Near-Term Provisions

  • Reporting on employees’ W-2s
    the value of health benefits
    (starting in 2011)................................ 22%................. 31%................. 29%...................... 18%
  • Auto-enrollment of employees
    in healthcare coverage
    (effective date not yet certain) ......... 17%................. 20%................. 39%...................... 24%
  • Option to auto-enroll employees
    in long-term healthcare plans
    per the CLASS Act provisions
    (employees can opt out).................. 14%................. 21%................. 32%...................... 33%

Provisions between 2012 and 2018

  • Increase in Medicare tax on
    high-income individuals..................... 31%................ 26%................ 27%...................... 16%
  • Tax on certain net
    investment income............................. 26%................ 17%................ 30%...................... 27%
  • “Cadillac” plan excise tax.................. 20%................ 12%................ 45%...................... 23%
  • Elimination of waiting
    periods more than 90 days............... 16%................ 15%................ 51%...................... 18%
  • Penalties for companies
    (with 50+ employees) that fail
    to provide coverage or do not
    provide minimal affordable
    coverage............................................... 9%................. 10%................ 66%...................... 15%       

Despite uncertainty, CEOs plan for change
Despite uncertainty about the impact of the Act, many Trendsetter CEOs say they intend to change current processes and plan structures: 70% of respondents plan to re-evaluate their companies’ overall benefits strategy; 60% plan to change their benefits; 52% are likely to significantly change employee contributions for medical coverage; and 42% are likely to increase their companies’ investments in wellness programs.

“That a considerable number of CEOs are looking to up their investment in wellness programs signals a shift in thinking," says Esch, "with greater focus on a long-term approach to the health of employees ¾ one that emphasizes preventive measures. This, in turn, should help companies contain healthcare costs in the long run.”

                                                                                                                                    Not certain/  
Likely Company Actions                                  Likely                  Unlikely              Not reported

  • Re-evaluate your overall
    benefits strategy......................................... 70%...................... 25%........................ 5%        
  • Change your company’s
    benefits to comply with the Act................. 60%...................... 28%...................... 12%       
  • Significantly change employee
    contributions for medical coverage.......... 52%...................... 31%...................... 17%                   
  • Increase your company’s
    investments in Wellness programs.......... 42%...................... 44%...................... 14%       
  • Cover employees through state-run
    health insurance exchanges
    (available in 2014 for small employers,
    and in 2017 for large ones)....................... 17%...................... 49%...................... 34%       
  • Set up or significantly change
    retiree medical benefits................................ 7%....................... 52%..................... 41%

Interestingly, of the 11% of respondents whose healthcare plans cover retirees, nearly half (46%) are likely to significantly change their current retiree programs; 37% are unlikely, and 17% are uncertain.

“The potential business impact of health reform is just one among a host of issues - regulatory, legislative, economic - that's creating uncertainty for CEOs right now,” concludes Esch. “We’re advising our clients that with proper planning and a big-picture perspective, they can effectively navigate through these challenges and emerge a stronger, more efficient business.”