Despite the uncertainty and legal challenges over the PatientProtection and Affordable Care Act, credit unions need to stay thecourse and proceed with changes required by the law, said BradPricer, senior manager of employee benefits product management atCUNA Mutual, during the Texas Credit Union League's annualmeeting.

Passed a little over a year ago, the health care reform debateand legal challenges have left many employers unsure how to proceedwith mandated changes. Credit unions aren't alone with theirdoubts. A recent Deloitte survey found that managing health carecosts continues to be the top priority for employers, andrespondents indicated that compliance with the law has made it morechallenging.

“Most employers have no current plans to significantly altertheir health care programs. This may change as elements of thereform legislation take shape, especially in the design, pricing,efficiency and acceptability of the new state health exchanges.Employers may have new choices,” said Steven Kraus, a principal atDeloitte Consulting LLP.

Consistent with concerns related to total health care dollarsspent, when asked to choose their organization's primary focus inaddressing health care reform over the next three years, 63% ofrespondents selected “we will focus mostly on controlling our totalhealth care costs.” At the same time, only 9% selected “we willfocus mostly on ensuring we comply with minimum mandatedstandards.”

Not acting, Pricer said, would be a mistake.

“There are approximately 25 lawsuits filed by numerous stateschallenging the constitutionality of various provisions of thehealth care reform laws creating much political discussion and anuncertain path for business owners and employees,” Pricer said.“For example, a recent federal court decision in Florida found thehealth care reform law to be unconstitutional. Yet, the decision inFlorida clearly states that the health care reform laws are stillin effect. It is important to understand that this decision is notsettled as appeals are almost certain to take place.”

Encouraging a full-speed-ahead approach, Pricer highlighted someof the key provisions of the law that are slated to go into effectin 2011:

• Consumer rebates for excessive medical loss ratiosare available.

• Employers may optionally report health coveragecosts on form W-2.

• “Qualified Medical Expenses” now conform to thedefinition used for the itemized tax deduction.

• Employees need a prescription to be reimbursed forover-the-counter medications and supplies run through their healthFSAs, HRAs, HSAs and Archer MSAs.

• A simple cafeteria plan is created to provide smallbusinesses an easier way to sponsor a cafeteria plan.

• Medicare Part D discounts are instituted.

• Grants for wellness programs are established.

Pricer added that while it may seem overwhelming for HRdepartments, there are resources available to help, such as onlinetools– timelines, legislative briefs, model notices and forms areavailable at www.cunamutual.com.

“One way to think about the employer implications of healthreform is to think in terms of minimum standards. Beginning in2014, employer plans will have to be designed with respect toeligibility and coverage rules, affordability and actuarialequivalencies, minimum essential benefits and a host of otherthresholds. It's a compliance imperative, but it may also serve asa stimulus for innovation,” said Kraus.

The Deloitte survey also found that topping the list to managerising health care costs once again in 2011 was increasing employeecost-sharing for active employee plans (62%). A close second at 59%was expanding wellness programs to help manage costs. The surveyrevealed an increase in plans to encourage more active employeeparticipation in wellness and disease management programs in2011.

In addition, 13% of respondents will consider replacing allcurrent health plans with a consumer-driven plan and 14% willconsider offering such a plan as an option.