employees who might previously have been discomforted by the possibility
that their employers would stop providing coverage may now be much
more accepting of, and perhaps even desire, that change.
6. Differential advantage: As with all change, there will be winners and
losers; the question in a particular company may not be “which approach is
better,” but rather, “which is better for whom?” Moreover, the perception of
who gains and who loses may not match the reality, and the angst over the
possibility of losing is a factor in itself. An employer who discontinues
coverage or sets up a private exchange may benefit one class of its
employees while disadvantaging others. Employers who make a choice
about whether and how to comply with the ACA without carefully
assessing their employees’ likely reaction may be shooting themselves in
the foot. And, as noted above, some employees who are impacted, or who
perceive themselves to be impacted by the change, may be better positioned
than others to make their voices heard and responded to by their
7. Compensation equity: Closely related to the preceding point, some
employees who lose employer-provided health coverage may be given, or
be able to get, higher wages to make them whole, or perhaps even improve
their position. This adjustment of compensation may come more or less
automatically and immediately or it may come about only after a period of
employer-employee tension and negotiation; and, as noted above, it may
come about for some parts of an employer’s labor force and not for others
8. Diplomacy: How an employer goes about deciding what to do about
health insurance and how it involves its employees in the decision process
— i.e. making clear that it is taking their interests and feelings into account
— may matter as much as the substance of the decision.
9. What other employers do: In all situations, there are leaders and
followers. As Dr. Emanuel points out in his predictions,197 there will be
industry leaders who will take action and point the direction others will
follow. It’s impossible to foresee how this factor will play out and how it
will affect employers’ actions.
customers are satisfied with their coverage).
196. For example, managerial class employees may be able to “push back” against an
employer’s decision to stop providing health insurance while rank-and-file workers in the
same company have no recourse but to accept it.
197. See Emanuel, supra note 171 at 317-318.