Half of Americans get health coverage through their employers, who are facing numerous pressures when it comes to offering healthcare, including rising costs.
That’s why the Commonwealth Fund launched the National Task Force on the Future Role of Employers in the U.S. Health System in early April. In 2025, the task force will release a blueprint of recommendations on how employers can bolster health coverage for their employees and will consider topics like challenges in offering affordable insurance and policy proposals that could improve employer-sponsored insurance.
The Commonwealth Fund, based in New York City, is a private foundation that is focused on promoting an equitable healthcare system.
There are 18 members on the task force and they include former health industry executives, researchers and employer coverage experts. Some of them come from organizations like the Urban Institute, Harvard University and the American Enterprise Institute. Several of the task force members were previously employed at large employers, but have since retired. Its co-chairs are Peter Lee, senior scholar at Stanford University’s Clinical Excellence Research Center, and Sherry Glied, dean of Robert F. Wagner Graduate School of Public Service at New York University. The task force is staffed by the Commonwealth Fund’s Sara Collins and Lovisa Gustafsson, and the organization is funding the project.
What the task force hopes to achieve
Since the passage of the Affordable Care Act, the health insurance landscape has changed drastically, including allowing states to expand Medicaid and providing subsidies for health insurance to eligible Americans. However, employer-sponsored health insurance has largely gone untouched, according to Glied, co-chair of the task force.
She added that when the ACA passed in 2010, there were concerns that it would cause the “withering away” of employer-sponsored insurance.
“But in fact, employer-sponsored insurance remains the predominant way that people under 65 get their health insurance,” Glied said in an interview. “So although we’ve had this big health reform, we added a bunch of pieces to the healthcare system, we covered a lot of people, we actually didn’t take a very hard look at the system that continues to exist and continues to thrive. It seemed like it was time to do that to see how the system is working and what the challenges are with it.”
One of the major challenges employers are facing is healthcare costs. U.S. employers’ healthcare costs are expected to reach more than $15,000 per employee in 2024, an 8.5% increase from 2023, according to a recent Aon report.
In addition, employers have a diverse range of workers, and the system doesn’t work as well for low-income workers who often have to pay the same premiums as high-income workers, Glied noted. And as the healthcare industry deals with a lot of consolidation, there is also growing concern about whether employers actually have good bargaining power to keep costs down, she said.
Lee, also co-chair of the task force, added that while the majority of Americans with employer-sponsored insurance are getting “pretty good coverage,” it’s a “luck of the draw of who you happen to be employed by.”
To tackle these issues, the task force will consider a range of actionable solutions for employers and look at the evidence behind those solutions so that they don’t cause “undue harm,” Lee said. The group may do some modeling and economic review of these solutions and provide a draft set of recommendations to get feedback from key stakeholders, including employers. While the members of the task force have deep experience with employer-sponsored insurance, they are not currently working on behalf of employers.
“We wanted people who had enough perspective to understand the employer view, but not be invested or part of it today,” Lee stated. “So part of having final recommendations is to run the potential recommendations by those that are in the system today. To say, ‘Does this work? Does this pass the smell test?’”
Sara Collins, senior scholar and vice president for health care coverage and access at the Commonwealth Fund, added that the task force will be considering solutions for both self-funded and fully-insured employers, who face different challenges.
“We’re wanting to see where the pressure points are, wanting to hear from people who have been associated with large and small firms and what particular challenges they view employers facing,” Collins said.
Lee noted that it’s not clear whether employer-sponsored insurance makes “fundamental economic or structural sense,” but the task force will “take that as a given.” Most developed countries don’t have insurance tied to employment. But rather than recommending overhauling the system as a whole, the task force will examine how to improve it.
“What this task force is doing is dealing with the world of the present and the reality that when we look ahead in the foreseeable future in America, employers will continue to play a central role in coverage. Does that make sense? Probably not. … [but] a core part of our goals is to be actionable and practical,” he said.
Experts are mostly applauding the task force
Ellen Kelsay, president and CEO of the Business Group on Health, said the organization “holds that the exploration of topics is essential for the continued strength and delivery of coverage under the employer-provided system.” Business Group on Health is a nonprofit that has over 440 large employer plan sponsor and health industry partner members. Kelsay is not part of the task force.
But the fact that there aren’t any employers on the task force gives Kelsay “slight pause.”
“We strongly believe that meaningful progress stems from collaborations by multiple industry stakeholders who are actively engaged in the current and future ecosystem,” Kelsay said in an email.
However, another employer expert believes that the Commonwealth Fund has brought together really impressive people, including Dr. Robert Galvin, former senior executive at General Electric, and Sally Welborn, former senior vice president of global benefits for Walmart Stores.
“They’re gathering together a lot of people with considerable experience in designing and financing employer-sponsored healthcare, and a bunch of very thoughtful and prominent academics,” said Dr. Jeff Levin-Scherz, WTW’s population health leader, in an interview. “I think it’s exciting that they’re doing this and it’s a good time to convene experts to think about the opportunities to make this very expensive system work better for patients, work better for providers, work better for employers.”
WTW is a global advisory, broking and solutions company.
In addition to healthcare costs, Levin-Scherz said he hopes the task force addresses issues around mental health and healthcare workforce shortages.
What is the end goal?
The task force expects to release its recommendations in a report about a year from now, according to Collins.
“We are looking to develop a blueprint of recommendations that are actionable, not bound by today’s politics, and setting a blueprint that could be a reference point over time,” Collins said.
Lee added that the blueprint will focus specifically on what employers can do.
“There are a lot of efforts focusing on the biggest issue facing both employees and employers, which is the cost of health care,” Lee said. “Those efforts include policies looking at drug pricing and issues in transparency and competition. There have been virtually no efforts to say, ‘What about employers themselves as the entity that is responsible for providing coverage? What about their roles? What can be done to make sure they’re doing the best job possible? That’s what this task force is looking at.’”
Photo: Natee Meepian, Getty Images
