For the majority of employers, the question of whether to moveemployees to the Obamacare exchanges is similar to so manybusiness decisions they make throughout the year.

“It really is all about the bottom line and the results ofcost-benefit analyses,” said Iris Tilley, an employee benefitsattorney in Portland, Ore. “That's what I'm hearing mostly fromclients, and when they seek our advice about health care, we areencouraging them to undergo the means test and figure out what makes the most sense for their business.”

In general, Tilley said those employers who are contemplatingmigration most seriously include companies with fewer than 50full-time employees, those with high health insurance premiums orthose who employ high-wage workers.

She said for them, an exchange migration might pencil outbecause they won't face pay-or-play penalties, or if they do, thepenalties for some of those organizations likely will be lessexpensive than the cost of providing health carecoverage.

Examples in that latter instance would include employers with agenerally younger workforce, or employers with easy-to-replaceemployees.

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One of the biggest advantages to moving to a public exchange maybe the handing over of the financial and administrative burdens inrunning a company's health benefits.

That could sway some employers, but not all.

Take Harold Wood, for example. He employs seven people in anauto-body shop in Salem, Ore. Wood told the StatesmanJournal last week that he stopped offering health insuranceabout a decade ago because it was too expensive. He intends toexplore the Oregon state exchange, but at this point, he said heremains fairly pessimistic about health care costs.

“That's a wait and see, but again it better be good,” he said.“I frankly don't think it's going to be in the affordable range formost business people.”

But sometimes the bottom line is affected by the quality of theworkforce, and not just the amount of cash coming in and goingout.

Jeffrey Lewis, an employment law attorney in San Francisco, saidemployers who generally hire workers with unique and highly specialized skills might bemore cautious when it comes to foregoing health care coverage anddirecting employees to an exchange.

“Then, yes, in an extremely competitive marketplace, it couldbecome an issue, if you terminate coverage yet rival organizationscontinue to offer it (health care) as a way to attract and retainthe best, brightest and most sought after employees with keyskills to their companies,” Lewis said.

On the other hand, he said, “it could not be an issue at all ifyour highly specialized workforce is younger and possibly moreonline savvy and completely comfortable shopping for insuranceonline, via the exchanges.”

A recent report by Accenture estimated that roughly one out offive people will purchase their health benefits from an exchange inthe next three years.

It'll be a slow-go at first.

Next Page: An Issue of Readiness

“The issue right now is a lack of consumer readiness forexchanges, in general, but in particular for private exchanges,”said Rich Birhanzel, managing director of Accenture HealthAdministration Services. “While private exchange providers havebeen largely focused on educating employers on the benefits theyoffer, almost no education has been provided to employees who areconsidering enrolling in these health plans.”

Indeed, on Oct. 1, millions of U.S. consumers will begin toenroll in public exchanges under the Patient Protection andAffordable Care Act, while many private exchanges also are plannedto launch this year.

While Accenture estimated that only 1 million individuals areexpected to enroll in private exchanges by the end of 2013, thatnumber is expected to reach 40 million individuals by 2018,surpassing the 31 million individuals likely to enroll instate-funded public exchanges.

One reason employers might be more inclined to push employees toprivate exchanges rather than public ones is less of a pocketbookissue and more about political leanings, Tilley said.

“Health care reform is very politicized,” she noted. “And someemployers and employees may object to using the exchanges becausethey don't want to 'help' health care reform succeed.”

Politics aside, private exchange might be preferred by someemployers because using them means employees get an allowance fromthe employer that can be used to buy insurance.

The private exchanges are being developed by consulting firmssuch as Aon Hewitt, Mercer and Towers Watson, as well as retailers,such Walgreens, and even insurance brokers.

Private exchanges will allow employers to retain “key employerrelationships while transitioning those employers to definedcontribution,” Birhanzel said. There are also increasedopportunities to offer members a broader array of customizedproducts such as dental, life, and disability coverage.

The success of the private exchanges will be measured largely bytheir ability to reduce healthcare costs for employers and theability to provide consumer choice that leads to more efficient useof benefits by employees.