Critics fear other religious groups may raise similar objections. Evangelical Christians could oppose pediatric benefits for same-sex couples. Jehovah's Witnesses could oppose blood transfusions. Various religions could oppose vaccinations or medications derived from animals, they speculate.
Paul Keckley, managing director in Navigant's healthcare practice, asks: “Why are the companies in the middle of this to begin with? At what point does the employee sue the company for exercising its rights? My goodness, it's messy.” He predicted the decision will push more employers to abandon providing coverage, and instead provide tools for workers to get their own insurance.
However, other experts contend that many barriers remain to a wholesale employer flight from providing coverage. “The tendency of the press is to overreact to everything,” said Massachusetts Institute of Technology health-economics professor Jonathan Gruber, one of the chief architects of the Patient Protection and Affordable Care Act.
Those barriers include the pervasive economic reality of employer-based health insurance and the language of the opinion. About 57% of all companies offered health benefits in 2013, according to the Kaiser Family Foundation.
For family coverage, employers paid about $11,800 of the average $16,400 annual cost for a plan. Those corporate expenses, and often a portion of employees' expenses, are tax-free. For individuals, employers covered $4,900 of the average $5,900 plan. If a company gave workers a raise to pay for coverage and then axed its insurance program, the income would be taxed. Such arrangements would forfeit the federal tax write- off for workers and trigger corporate penalties under the Affordable Care Act.
More employers may decide to move to private exchanges, where workers could use tax-advantaged company funds to select among several plans. The private exchanges, most operated by major benefits-consulting firms, are similar in structure to the public exchanges that operate for the nongroup market.
“Many people predict that the private exchanges will eventually become larger than the public exchanges,” said Joel Ario, a managing director with Manatt Health Solutions. “If that decision is given to most people, and the exchanges actually work for most people … I don't know too many people who would prefer their employer to buy their coverage.”
However, there's also the matter of the Hobby Lobby decision itself. Justice Samuel Alito, writing for the majority, wrote that the decision was limited to the facts in this case, which involved objections to four of the 20 forms of birth control mandated for coverage under reform. “Our decision should not be understood to hold that an insurance-coverage mandate must necessarily fall if it conflicts with an employer's religious beliefs,” he wrote.
That statement didn't convince all observers. The court is well aware that more than 80 other private and not-for-profit organizations are still suing to block aspects of the contraception mandate, and virtually no one speculated that last week's decision would close the door on the high court considering other challenges to the law.
“I think it opens the door,” Blackwelder said. “This creates a precedent to other challenges and lawsuits. Once you start down a path, there are intended and unintended consequences.”
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