Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Journal Article


Large Employers See Scenarios Under Which They Could Move Workers and Retirees to Exchanges

The Issue

The health insurance exchanges created by the Affordable Care Act are targeted primarily at individuals and small employers. But they are causing many large employers to rethink their health benefits strategies, according to this Commonwealth Fund–supported analysis. Starting in 2014, large employees will have opportunities to use the exchanges for some of their employees and retirees and, starting in 2017, states will be allowed to open the Small Business Health Options Programs, or SHOP exchanges, to all those working in firms with more than 100 employees.

What the Study Found

Through interviews with large employers, benefits consultants, and policy experts, William Kramer examined employers' views on their potential use of the exchanges in the short term (2014–16) and over the longer term (2017 and beyond). He found that, in the short term, many large employers are considering using the exchanges for pre-Medicare retirees and part-time workers. Over the longer term, many employers are considering referring all their employees to the exchanges, with most contributing to the costs of purchasing benefits. Factors that will continue to affect employers' decisions include the viability of the exchanges as marketplaces, the future of the Affordable Care Act, and the strength of the economy. 


"After decades of frustration with attempts to improve the quality and affordability of the health benefits offered to employees, many large employers now see the possibility of new options," Kramer concludes. "This is allowing them to rethink their basic human resources strategies and consider alternatives to traditional employee health benefits."

Publication Details



W. E. Kramer, "Large Employers See Scenarios Under Which They Could Move Workers and Retirees to Exchanges," Health Affairs, Feb. 2012 31(2):299–305.