1. view
In this issue
22
Achieving business
agility
38
Maximizing talent
winter 08
46
Interview with
Andrew Zolli
and more...
Healthy
choices?
What election-year healthcare reform proposals mean
for the future of employer-sponsored health insurance 10
2. Departments
3
A new view Business success
in the 21st century
Tom Craren
4
My view The key to 21st-century
competitiveness: Finding the right people
Dennis Nally
52
Your view On constant change
View points
6
Solving the tech waste problem
7
Syncing up on info security
8
Joining the consumer conversation
9
The business of bribes
9
International assignments
Features
10
Cover story
22
Change agents Just whose job is it to
Healthy choices? What do election-year ensure your business can keep pace with
healthcare reform proposals mean for customers, competitors, and suppliers?
the future of employer-sponsored health Randy Browning
insurance? Sandy Lutz, Benjamin Isgur,
and Jeffrey Gartland
3. It’s time to check up on how election-year healthcare reform
will affect employers, page 10.
30
One global flavor A US move to
38
Maximizing talent There are strategies
46
Interview
International Financial Reporting for making the most of your people Piercing the veil Andrew Zolli looks
Standards is inevitable. All companies no matter what tomorrow brings. at the future of business and of the
should think strategically about this Steve Rimmer, Karen Vander Linde, world. Interview by Tom Craren and
change and begin to understand Dolores Wilverding, and Warren Cinnick Gene Zasadinski
the impact now. Raymond J. Beier
5. Business success
A new view
in the 1st century
According to naturalist and evolutionary As it does to 21st-century business,
theorist Charles Darwin, “It is not the change also applies to View. With a new
strongest of the species that survive, nor design, a new format, a new editorial
the most intelligent, but the one most approach, and an enhanced online pres-
responsive to change.” Whether his words ence, View is evolving to keep pace with
accurately describe biological processes a changing business environment.
is still a matter of heated debate. But there
is no debate about their applicability to In line with those changes, we intend to
21st-century business: Complex forces consistently offer business executives
of change are at work, and only those like you straight talk on subjects that
companies flexible enough to respond matter. Topics in this issue include health-
appropriately will survive and prosper. care policy, agility, International Financial
Reporting Standards, and strategies for
Addressing these forces of change is what finding and maximizing talent. And there’s
View is all about. In each issue we share also an interview with noted futurist
insights into challenges that most concern Andrew Zolli.
you and that affect your success—chal-
lenges such as embedding agility into We hope you enjoy this issue of View and
your company and making change stick; that you’ll come back often. We promise
discovering opportunities inherent in some to be a friendly, reliable, informative, and
risk; attracting and maintaining talent; entertaining place for you to check in on
maximizing your corporate social respon- and track the trends and issues that interest
sibility efforts; disarming complexity; and and concern you most, not just today,
fostering innovation and collaboration. but over time as well. We know your expec-
tations are high. We wouldn’t have it any
other way. You can be sure that we’ll deliver.
Sincerely,
Tom Craren
Partner-in-Charge
US Thought Leadership
PricewaterhouseCoopers View winter 08
6. The key to 1st-century
My view
Dennis Nally
competitiveness
Finding the right people
In today’s knowledge-based economy, talent
will be the defining competitive advantage.
And companies that want to succeed are
dramatically rethinking the way they find,
develop, and hold on to talent.
PricewaterhouseCoopers View winter 08
7. In today’s leading organizations, there is no We can start by increasing the visa cap for want us. Yes, that’s right, want us. Today’s
question that talent—finding it, developing international professionals who want to recruits have expectations about the
it, and retaining it—affects success more work in the US. This year, for the first time companies they want to work for. They are
directly than any other single factor. It also in history, the visa cap was reached on the looking for commitments to integrity, to
is among the greatest causes of concern. first day of filing. Applications arriving after social responsibility, and to flexibility. And
day-one were denied. they are in a position to demand this and
Our 11th Annual Global CEO Survey bears more. Companies that meet and exceed
this out. While 89 percent of CEOs assert This and other policies and approaches to these demands will win. Those that don’t
that their companies’ people agendas education and to developing talent need to will fall behind.
are among their top priorities, 61 percent change. I firmly believe that to maintain its
express concern over the availability of competitive edge, America must become Some companies will find that coping with
key skills. In addition, 62 percent maintain a magnet for talent. But until this happens, these new realities is difficult. Others will
that their organizations need to change we can’t just sit on the sidelines. We’ve pretend they don’t exist and continue on
the way they recruit, motivate, and got to find and cultivate talent in our own with the old ways. However, organizations
develop employees. backyards. We’ve got to recruit students that succeed will be those that neither
at an earlier age. And we’ve got to learn ignore change nor fear it. Rather, they will
Responses such as these to questions how to use newer technologies such as be those that respond to change and turn
about what, a decade ago, was a yawn- mobile email and text messaging as pow- it to their advantage.
inducing issue suggest that a fundamental erful, new recruiting tools. We also need to
shift has occurred. Perhaps more than any fully exploit rich sources of new talent And that’s my view.
other aspect of business, the competition such as virtual online communities and
for talent has changed profoundly. social networks. Dennis Nally is chairman and senior partner of
PricewaterhouseCoopers LLP. In the next issue of
The reasons are not difficult to find. They But most important, we have to find ways View, he continues to examine this critical issue and
are related directly to globalization and to of ensuring that the people we want also offers his insights on developing and retaining talent.
changes in demographics and technology.
89%
Finding the right people
There was a time—at least in the account-
ing profession—when the only talent you
needed involved understanding a balance
sheet and an income statement. Those
days are long gone.
Today, we look for people not only with of CEOs assert that their companies’ people agendas are among
technical skills, but with integrity as well.
We also look for people with diverse back- their top priorities.
6%
grounds and cultures—people who bring a
broader understanding of the world around
them. Without such people, a company
cannot compete globally.
However, tapping into this type of work-
force is easier said than accomplished, and
business leaders must work proactively to of CEOs maintain that their organizations need to change the
remove obstacles. But what can be done? way they recruit, motivate, and develop employees.
PricewaterhouseCoopers View winter 08
8. View points
Corporate social responsibility
Solving the tech waste problem
For businesses across the United States, burden of its products—a burden shoul- Research’s November 2007 report titled In
yesterday’s technology has become dered by its corporate customers. A Search of Green Technology Consumers—
tomorrow’s problem. The millions of com- recent study by PricewaterhouseCoopers which covered American attitudes toward
puters, printers, and other gadgets that are surveyed tech industry senior executives green technology—only 12 percent of
commonplace in any office—and that we on their companies’ attitudes and policies respondents agree that they would pay
steadfastly rely on to conduct business— on environmentalism. When asked which extra for consumer electronics that used
can become threats when we discard them. factors were most important in their com- less energy or came from a company that
panies’ environmental decision making, was environmentally friendly. Forty-one
In the United States alone, approximately nearly half of the respondents cited “meet- percent said that though they are con-
2 million tons of e-waste is tossed into ing customer expectations/requirements,” cerned about the environment, they do not
landfills, poisoning the air and the land and but energy savings and regulatory compli- strongly agree that they would pay more
exposing people to dangerous toxins. In ance had an even greater impact on their for environmentally friendly electronics.
addition, all that hardware—especially data environmentally focused pursuits.1
centers that house a company’s informa- Despite this disconnect, many technol-
tion lifeblood—is eating up a lot of energy. So, can customers expect more green ogy companies have jumped on the green
In fact, 50 percent of the energy consumed products when a company’s next bandwagon. For instance, Sony is creating
in a data center is used just to cool down upgrade cycle rolls around? According to an e-waste drop-off facility where anyone
the network system. PricewaterhouseCoopers/National Venture can recycle unwanted electronics. And
Capital Association MoneyTree™ Report many technology companies are collabo-
Along with these practical problems, com- based on data from Thomson Financial, rating with smaller organizations to develop
panies face the challenge of going green venture capitalists invested in 2007 almost and promulgate more environmentally
and reducing their carbon footprints. This $2.2 billion in companies that make green friendly processes.
is becoming important as public interest in tech products. That investment is more
environmentalism increases and as more than the amount spent on green technology Such initiatives and collaborations are
organizations want to position themselves companies in 2006 and 2005 combined. pivotal for making green technology
as socially responsible businesses. a reality for any business. They reduce
While such numbers are impressive, a energy costs and provide an alternative
The technology industry is beginning to considerable amount of resistance to to junking used hardware.
recognize and address the environmental green tech products still exists. In Forrester
1 Technology Executive Connections: Going Green: Sustainable
Growth Strategies, PricewaterhouseCoopers, 2008.
Motivation for environmental decision making
Percent of tech company executives surveyed
70
60.1
60
50.7
50
44.6 43.2
40
30
20 17.6
14.9 14.2
10 8.8
3.4
0
Potential Complying with Meeting Potential Obtaining Matching the Attracting and Meeting Don’t know/
cost savings environmental customer for gaining tax incentives environmentally retaining staff investor/ Not applicable
from energy legislation and expectations/ competitive focused actions shareholder
efficiency regulation requirements advantage of competitors demands
Source: Technology Executive Connections: Going Green: Sustainable Growth Strategies, PricewaterhouseCoopers, 2008
6 PricewaterhouseCoopers View winter 08
9. CEOs, CIOs, and CSOs differ in their attitudes
about business security matters.
Managing risk
Syncing up on info security
Executive views on security attacks
Percent of senior executives surveyed
100
83
80
71 74
65
60 53
50
44 43
40
38
CEO
20
CIO
CISO/CSO
0
An employee or A hacker as the Fewer than 10 security
former employee as source of an attack attacks in the past year
the source of an attack
Source: Fifth Annual Global State of Information Security Survey 2007, CIO, CSO and PricewaterhouseCoopers
CEOs worldwide might want to sit down page concerning the number one priority Despite security and technology execu-
with their information and security offi- for company information security efforts: tives’ growing awareness of the true
cers to discuss their differing perceptions maintaining business continuity and alle- nature of security threats, an overwhelm-
of risk. According to a recent global viating risk. CSOs, however, place greater ing number of CEOs still say hackers—not
information security survey conducted emphasis on regulatory compliance. employees—are the culprits who should
by CIO magazine, CSO magazine, and be targeted. However, CEOs believe more
PricewaterhouseCoopers, CEOs, CIOs Perhaps the most interesting finding con- so than their security counterparts that
(chief information officers), and CISOs cerns a change in perception with regard their organizations are secure and have
(chief information security officers) or to the source of security threats—an area experienced few attacks.
CSOs (chief security officers) differ in their that the survey has tracked for five years.
attitudes about business security matters. Today, CIOs and CSOs say former and So, how can these differences be rec-
The survey concluded that many CEOs are current employees are more likely sources onciled? The survey data leads to what
far more confident about their companies’ of security attacks than outsiders are. And is perhaps a counterintuitive conclusion.
security than their information technology they report that email and abused user While information security strategies need
(IT) and security leaders are. accounts are the most common methods to include technical approaches, such
of employee attacks. This change, however, technical approaches may not lead to the
Typically lacking in-depth technical knowl- does not suggest an increase in corporate whole solution. More extensive or wider
edge with regard to IT, CEOs naturally crime over the past few years. Rather, it information sharing between an organiza-
have different perspectives on information points to possible cracks that have devel- tion’s top executives could turn out to be
security from those of the executive team oped in information security infrastructure, equally if not more important.
members who manage these functions. and it indicates a greater awareness of the
Even so, CEOs and CIOs are on the same changing nature of security attacks.
PricewaterhouseCoopers View winter 08
10. View points
Operational excellence
Joining the consumer conversation
If you think surfing the Web is better suited consumer conversation, along with more How companies better understand their
to the home office than to the corner one, traditional customer information, into its customers and markets
think again. operations. Millions of Internet-savvy Engage with 2%
consumers are now able to (1) instantly customers 6%
Consider this scenario. Your company provide feedback via email and text via the Web
recently launched a product, and the messages, (2) deeply discuss products 39% 53%
buzz surrounding the innovation has been and services on message boards, and
rising steadily. Shortly after the launch, a (3) broadcast their opinions on blogs
hazardous defect was detected. You do and social networking sites. This largely
the damage control drill—recalling the untapped chatter constitutes consumer
product, reaching out to the media, and conversation—reflecting the attitudes,
gauging customer reactions through your behaviors, and intentions of consumers.1 Monitor customers’ 3%
call center and focus groups. You hope online behavior and 9%
your collective response is enough to The massive volume and rapid pace of preferences 31%
minimize damage, but you’ve overlooked online activity make getting a handle on this
one important thing: online consumer fertile ground problematic. Hiring the right
conversations. Damage was brewing in people and finding the right tools to analyze
blogs and message boards as angry con- 57%
business intelligence based on consumer
sumers dissected your product’s downfall conversation are critical. According to
and debated alternatives. If only you had PwC’s Management Barometer, which reg-
been listening, your company could have ularly surveys senior executives on crucial Mine open-ended
responded proactively. 3%
business issues, 31 percent of respondents comments from
13%
monitor their customers’ online behavior on service and
The world of digital communications a regular basis. Fifty-three percent say their support calls 42%
is burgeoning, and for any business to companies use online devices to engage
succeed, it must embed this kind of digital with their customers.2 42%
A consumer electronics company real-
ized the benefits of this approach when its
new product was not selling as robustly Understand views 3%
as expected. Through analyzing online of key influencers
12%
consumer conversations, the company (advisory boards,
discovered that many customers thought experts)
55%
the product was incompatible with other 30%
brands. After the company changed its
marketing campaign, the product went
on to become a top seller.
As this example demonstrates, compa- Collect and analyze 2%
nies that engage in digital conversation observations by 3%
14%
by analyzing and integrating the findings employees who
with other customer data, and, ultimately, interact with or
by embedding this intelligence will be well observe customers
positioned to drive business transformation 81%
and gain competitive advantage.
1 PricewaterhouseCoopers, How Consumer Conversation Will
Yes No Not certain Not applicable
Transform Business, January 2008.
2 PricewaterhouseCoopers Management Barometer: Consumer Source: PricewaterhouseCoopers Management Barometer:
Conversations, January 2008. Consumer Conversations, January 2008
8 PricewaterhouseCoopers View winter 08
11. Global mobility
International
assignments
Economic crime North American companies reported having Money doesn’t always make the world go
been asked to pay a bribe in their home ’round. Organizations are discovering that
The business of bribes region, as opposed to 21 to 54 percent of it takes more than high salaries to attract
companies doing business in E7 countries. the best potential candidates to interna-
Interestingly, the survey also found that tional assignments.
companies asked to pay kickbacks were
more likely to lose deals to competitors that Recent studies we have undertaken sug-
were not asked to pay bribes. gest that the nature of global mobility is
This is the deal your company needs to changing.1 Whereas in the past, busi-
secure a position in a vital emerging mar- Why do businesses that succumb to nesses were interested mainly in hiring
ket. In the middle of negotiations, you’ve bribery suffer losses? The study suggests experienced staff from the West, today’s
been asked to grant a “commission” to that organizations known to be ethical are expatriates are being recruited from around
secure the contract. Should you pay— less likely to be approached with requests the world. They include younger, less ex-
just this once? for illicit money. Corrupt individuals prefer perienced workers, who serve for various
to deal with companies whose ethical lengths of time. In fact, in an effort to re-
According to a recent PwC study on global standards are ambiguous. In addition, duce costs, a growing number of organiza-
economic crime, corporate bribery rarely business relationships based on illegal tions have developed program alternatives
has positive results. transactions are not likely to focus on qual- to the traditional expatriate assignment.
ity and price—an indicator that the market Almost half the companies we surveyed
For our 4th Biennial Global Economic Crime is not operating according to competi- employ permanent transfers; about 20
Survey, we interviewed more than 5,400 tive norms. And companies in the E7 that percent send employees on short-term
companies in 40 countries and found that had implemented effective anticorruption assignments; and a small percentage use
companies in E7 countries (Brazil, China, controls and strong, clearly understood virtual staff where the employee does
India, Indonesia, Mexico, Russia, and ethical guidelines said they suffered up to not relocate but has responsibilities for
Turkey) reported higher incidences of being 50 percent fewer incidents of corruption a foreign office.
asked to pay a bribe.1 Only 3 percent of than other companies.
Changes are also occurring in the area of
In short, the study supports the old adage staff incentives to move abroad. It’s no
1 PricewaterhouseCoopers 4th Biennial Global Economic Crime
that honesty is the best policy when doing longer enough to simply increase salaries or
Survey - Economic crime: people, culture and controls, 2007. business in any market. provide other monetary perks. Employees
want a total package that delivers a cul-
tural education, keeps spouses happy, and
sets out reasonable career expectations.
Lost business opportunities in emerging markets The costs of sending employees and their
families abroad are high. If an employee is
Percent of companies surveyed
80
unhappy in the new environment, he or she
71 70 can jeopardize an overseas project. By im-
70 66 proving the help that employees get prior to
63
60 58 Companies and during their international assignment,
asked to pay
50 45 47 a bribe and lost companies can maximize their investments
an opportunity in the development of global talent.
40
31 Companies
30 never asked
23 21 to pay a bribe
20 18 17 18 and lost an
14 opportunity
10 8 6
Source:
0 4th Biennial 1 International assignment perspectives: Critical issues facing the
Brazil China India Indonesia Mexico North Russia Turkey Global Economic globally mobile workforce, PricewaterhouseCoopers, July 2007.
America Crime Survey
PricewaterhouseCoopers View winter 08 9
13. What election-year
healthcare reform proposals
mean for the future of
employer-sponsored health
insurance
By Sandy Lutz, Benjamin Isgur, and Jeffrey Gartland
As the presidential campaign reaches a fever pitch, candidates on
both sides of the aisle are promulgating their positions on every-
thing from fiscal policy to the war in Iraq. One of the most closely
followed public debates centers on healthcare reform. Although
all voters have a vested interest in the discussion, voters who are
also employers may be most affected by its outcome.
If you are an employer, spiraling healthcare costs are eating
away at your bottom line. According to the US Census Bureau,
177 million Americans rely on employer-sponsored insurance
for their health coverage. At 16 percent of the US economy and
growing, healthcare is big business—maybe even your business.
Moreover, the health plan options companies offer have become
key factors in employee recruitment and retention. Current (and
prospective) employees are asking a number of questions. How
comprehensive is the existing coverage? How many choices
do I have? How much is it costing (going to cost) me? Can I do
better elsewhere?
It’s no wonder, then, that healthcare consistently ranks as one of
the top domestic policy issues on the minds of Americans and
that during election years healthcare policy becomes a focal point.
(See Figure 1.) Employers, employees, and politicians alike agree
that the system is not sustainable and that there is no clear path
ahead. As one might expect, Democrats differ from Republicans
in their respective approaches to healthcare reform. Generally,
Democrats favor broader and more immediate changes through
legislation, while their Republican counterparts focus primarily on
changes to tax policy as the means of transforming the system.
PricewaterhouseCoopers View winter 08 11
14. However, all of the major candidates agree For US businesses, too, the significant income for tax and payroll purposes. In fact,
that a single-payer model is not tenable and cost of healthcare is a major concern, one recent study found that employees
that going forward, our healthcare system particularly when one considers that would rather receive thousands of dollars
will continue to be a public-private partner- while just 61 percent of US businesses in employer-sponsored insurance benefits
ship. Just what that partnership will look offer health insurance to at least some than the same amount in additional salary.
like is the key question. And top of mind for employees, a whopping 98 percent of (See Figure 4.)
employers is cutting through the election- large businesses (those with 200 or more
year hype and determining what it really workers) do the same.3 Employers typically The future course for employer-sponsored
means to the future of their businesses. spend upwards of 10 percent of payroll insurance may depend largely on the
on health insurance for their workers. (See policies initiated by the next president of
Scoping the problem Figure 3.) Taken in aggregate, that’s a huge the United States. A new leader will help
number—nearly $600 billion, according to decide important policy questions con-
Healthcare spending has been increasing at
the US Department of Commerce’s Bureau cerning covering the uninsured, improving
about twice the rate of inflation, absorbing
of Economic Analysis. the quality of care, and using taxes and
a larger and larger share of both employers’
other mechanisms to fund coverage. Pro-
profits and workers’ salaries. (See Figure 2.)
It wasn’t always that way. Employer- posals run the gamut from mandating that
For employees, healthcare cost is the top
sponsored insurance was introduced dur- all employers provide coverage to doing
financial concern facing American fami-
ing World War II as a relatively inexpensive away with employer responsibility alto-
lies, ranking higher than home ownership,
way to recruit and retain employees in a gether. The major differences among the
energy costs, debt, retirement savings, and
tight labor market where wages were frozen possible approaches involve the following
college expenses, according to a recent
by the federal government. Americans broad categories: employer mandates,
Gallup Poll.1 The problem is compounded
quickly became accustomed to healthcare government and worker responsibility,
because the high cost of healthcare in the
coverage as a benefit of employment. They retiree coverage, tax policy, market
United States is directly related to growth in
have also gotten used to the favorable tax reforms, and cost control. (For a snap-
the number of uninsured people, especially
treatment of employer-sponsored insur- shot of the Democratic and Republican
when premium increases exceed personal
ance benefits under current law, in which approaches to healthcare, see “Opposing
income growth, thus making insurance
the premiums are excluded from their views,” beginning on page 20.)
less affordable.2
1 Gallup Organization, What Is the Most Important Financial Problem Facing Your Family Today? Gallup Poll Social Series, July 12–15, 2007.
2 Todd Gilmer and Richard Kronick, “It’s the Premiums, Stupid: Projections of the Uninsured through 2013,” Health Affairs, vol. 25, no. 6 (2006).
3 The Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits: 2007 Summary of Findings, September 2007.
1 PricewaterhouseCoopers View winter 08
15. Figure 1: America’s big concern Percent of Americans surveyed, citing healthcare as the nation’s most important problem
1991
1992
1994
1996
1997
1993
1995
2007
1998
1999
2000
2001
2002
2003
2004
2005
2006
30
25
20
15
10
5
J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S OND J FMAMJ J A S
1992 1996 2000 2004 2008
Presidential Elections Presidential Elections Presidential Elections Presidential Elections Presidential
Elections
Clinton’s Task Force on
National Health Care Reform
Source: PricewaterhouseCoopers, Beyond the Sound Bite, 2007, based upon PwC Health Research Institute analysis of Gallup’s Most Important Problem series, October
11-14, 1990 through September 14-16, 2007
Figure : Healthcare’s growing 80
share of consumer spending
Percent change in wallet share of 70
personal consumption components
60
50
40
30
20
10
0 Medical care
Services, excluding
–10 medical care
Source: PricewaterhouseCoopers, Beyond –20 Durable goods
the Sound Bite, 2007, based upon PwC Nondurable goods
Health Research Institute analysis of data –30
from the Bureau of Economic Analysis,
“Personal Consumption Components,” 2007 1980 1985 1990 1995 2000 2005
Figure : Rising employer Figure : Health insurance trumps pay increases
healthcare costs Employer Percent of respondents who would rather have
premium contributions as a $6,700 in employer-sponsored health insurance—
share of payroll the average amount spent by employers on each
employee at the time of the survey—over the same
amount in additional taxable income
5%
20%
10.7%
9.8%
Prefer employer-
75% sponsored insurance
8.0% Prefer higher pay
Don’t know
Source: R. Helman and P. Fronstin, 2006 Health Confidence
Survey: Dissatisfaction with Health Care System Doubles Since
1996 2000 2003 2005 1998, EBRI (Employee Benefit Research Institute) Notes, vol. 27,
no. 11, November 2006, and earlier publications based on the
Source: Bureau of Labor Statistics’ Research Data Center, Employment Cost Index, data accessed from February 2006 to April 2007 EBRI Health Confidence Survey
PricewaterhouseCoopers View winter 08 1
16. Figure : Employer attitudes changing on providing coverage
Percent of respondents who say employers should move away from
providing healthcare coverage for active employees
6%
7%
Disagree
87% Agree
Neither
PricewaterhouseCoopers Health Research Institute, Tailoring the approach: Employer attitudes
and healthcare strategies address distinct issues, 2007
Pay, play—or no way
Figure 6: Overview of existing state employer mandates According to our analysis of US Census
Bureau data, 47 million Americans—more
Vermont
Catamount Health
than 15 percent of the population—do
Employers that do not offer health insur- not have health insurance. Of those, a full
ance, that offer health insurance only to two-thirds have a connection to a full-time
some employees, or that have uninsured job; that is, they either hold full-time jobs
employees must pay a quarterly assess- or are dependents of those who do. Given
ment fee of $1 per day per full-time these statistics, it is not surprising that
equivalent (FTE). FTE exceptions will be
made through 2010. The employer assess-
both of the major political parties consider
ment rate will be raised at the same rate addressing the working uninsured to be a
as Catamount Health premiums. high priority.
To expand access to care, proposals
from the leading Democratic candidates
require employers to provide worker health
coverage. This approach, often referred to
as pay or play, encourages employers to
fund employee health insurance by taxing
employers that do not.
The Democratic mandates strengthen and
expand the employer’s role in the health-
care market. Today, however, many large
companies agree that employers must
offer a minimum level of coverage. In a
recent PricewaterhouseCoopers survey,
150 US executives at large, publicly held
companies agree, with 87 percent reject-
ing the notion that employers should not
provide such coverage. (See Figure 5.)
Since 2005, 31 states have proposed
Hawaii Massachusetts a form of pay or play, and employer
Prepaid Health Care Act Act providing access to affordable, mandates have already been enacted in
Employers must provide health insurance for quality, and accountable healthcare
employees working over 20 hours per week. Employers must enroll at least one-fourth
Hawaii, Massachusetts, and Vermont.
Employers must contribute 50 percent of the pre- of employees in an employer-sponsored (See Figure 6.) In Massachusetts, employ-
mium for single coverage and the employee covers plan or pay at least one-third of employee ers with at least 10 workers pay each
the additional portion of the premium. Employee healthcare premium costs. Penalities for worker $295 per year if they do not make
contribution is not to exceed 1.5 percent of wages. failure to adhere to the mandate are $295 a “fair and reasonable” contribution to the
per employee per year. cost of workers’ coverage. In this case,
fair and reasonable means either enrolling
25 percent or more of full-time equivalents
Employer mandate passed (FTEs) in the employer’s plan or offering to
pay at least 33 percent of FTEs’ premiums.
Source: National Conference of State Legislatures Universal Employer mandate attempted 2005, 2006, or 2007
Health Care Action Network and Progressive State Network,
Towards Health Care for All in the States, September 19, 2007 No mandate being considered at this time
1 PricewaterhouseCoopers View winter 08
17. An individual mandate could coexist with an
employer mandate, potentially offering workers
affordable coverage options both through their
employers and in the individual market.
The mandate proposals generally estab- for by the government and administered by tend to believe that existing government
lish a minimum employer contribution. For private plans. Other Democratic proposals programs are underutilized. Rather than
example, if an employer currently pays include (1) a new government health insur- expanding government programs, leading
at least 6 percent of payroll costs toward ance option wherein individuals could Republicans would prefer that the gov-
employee health insurance, the employer purchase coverage (the program would ernment focus on enrolling uninsured
would be exempt from any further contri- be modeled after Medicare but not funded Americans who are eligible for Medicaid
bution. If the employer provides no health through the Medicare trust fund); (2) a new and for SCHIP but who haven’t signed up.
insurance or pays less than 6 percent of program that would mirror the Federal
payroll, the employer would have to con- Employees Health Benefits Program and Both parties advocate changing the
tribute to a public pool that brings the total make the same private insurance options individual’s role in the healthcare system.
contribution up to 6 percent of payroll. The enjoyed by federal employees available Democrats would start with an individual
public pool would then subsidize coverage to all Americans; and (3) the development mandate—that is, with a requirement that
for the uninsured. of a national health insurance exchange individuals procure health insurance similar
that would set standards for participating to the requirement in many states that
Generally speaking, Republicans do not plans and facilitate the purchasing of individuals procure automobile insurance.
support this approach. They oppose individual coverage. An individual mandate could coexist with
additional federal regulations on the health an employer mandate, potentially offer-
industry and specifically reject mandates. Republicans support proposals that would ing workers affordable coverage options
They counter that an employer mandate strengthen the individual insurance market both through their employers and in the
may not be effective unless the penalty is by extending to that market some of the individual market. Individual mandates
high enough to make purchasing coverage favorable tax treatment that is currently could be supported by new rules like
attractive. Some critics add that mandates available only for employer-group cover- guaranteed insurability and community
might cause employers to hire more part- age. Strengthening the individual market rating, which consist of pricing everyone
time or temporary workers who would not would not only provide tax support in a given geography the same, thereby
be subject to mandates. for people who do not have access to creating a large pool that spreads the
employer coverage; it would also offer risk. Together, guaranteed insurability and
Changing government and worker roles more insurance-product choices to community rating facilitate portability of
employees who currently are limited to just insurance—something both parties agree
Bolstering or diminishing the employer’s
one or two health plans. Also, Republicans on. A variation on this approach involves
role in healthcare is just one lever that is
being used to address healthcare reform.
How the parties see the responsibility of
the federal government and the respon-
sibility of individuals is another key issue
that also gets at the problem—and directly
impacts employers.
Democrats generally favor expanding
government programs such as Medicaid
and the State Children’s Health Insurance
Program (SCHIP). Many support a new
government-sponsored health insurance
program wherein individuals could pur-
chase coverage. This could benefit health
plans if the program were structured like
the Medicare drug benefit, which is paid
PricewaterhouseCoopers View winter 08 1
18. Health costs
600 1
billion USD is the amount
employers spend on health
million Americans rely on
employer-sponsored insurance
million Americans, more than
15 percent of the population,
insurance for their workers, for their health coverage. do not have health insurance.
upwards of 10 percent Of those, a full two-thirds have
of payroll. a connection to a full-time job.
PricewaterhouseCoopers View winter 08
19. Even employers that believe they have a
responsibility to provide health coverage
access for retirees also feel there are limits
to that responsibility.
an individual mandate only for children that by employers—a level that commonly
is supported through expanded govern- approaches annual family premiums of
ment programs. $15,000 or more.
Republicans oppose individual as well as Whichever coverage proposals prevail,
employer mandates. They argue that an they will affect employers. On one hand,
individual mandate may not be effective public-plan options may crowd out private
unless it is coupled with a severe penalty insurance if insured individuals drop their
for those who do not enroll in a plan. For private coverage in favor of less expensive
example, in Massachusetts—a state that government coverage. Or employers—
currently has an individual mandate—the especially employers of low-wage
penalty is loss of the individual exemp- workers—may decide not to offer insur-
tion. However, the value of the $3,500 ance when public alternatives are readily
tax exemption ranges from $0 (for lower- available. On the other hand, any plan that
income individuals not paying taxes) to covers more people may have the effect
$1,225 (for individuals in the 35 percent of lowering overall insurance premiums,
tax bracket). Given that the average annual a trend that could benefit employers.
premium cost of single coverage exceeds
$4,000, the penalty might not encour- The retiree dilemma
age many of the uninsured to purchase
Covering active workers and their depen-
insurance. In practice, a mandate would
dents is one thing, but what about the
likely be limited to those who can reason-
burden of providing coverage for retirees?
ably be expected to afford private health
Even employers that believe they have
insurance. Unless significant subsidies
a responsibility to provide health cover-
are provided for middle-income uninsured
age access for retirees also feel there are
people, such individuals cannot afford to
limits to that responsibility. In a recent PwC
purchase the level of insurance provided
survey, employers were less than certain
about their future support for retiree health
coverage. When asked to describe their
views on the topic, nearly three-quarters
said retiree health coverage is placing
Figure : Employer attitudes on retiree health coverage In describing your views about financial pressure on companies and that
retiree health coverage, do you agree at least somewhat with the following statements? such coverage will need to be changed
Percent agreeing through reduced employer contributions
and benefit caps. However, employers
Retiree health coverage is placing do show strong support for assisting
financial pressure on companies and
will need to be changed via reduced 73 employees in managing their own
employer contributions and benefit caps retirement health and associated costs.
Employers should help provide For example, nearly 80 percent support
access to affordable retiree health 74 providing retirees with savings account
coverage but not necessarily fund it
mechanisms, tax incentives, and access
Employees should set aside money to coverage even if they do not fund it.
during their active employment years 79 (See Figure 7.)
to fund their retirement healthcare needs
The parties’ proposals on retiree healthcare
There should be more tax incentives
for employees to set aside money to 80
closely mirror their positions on increasing
fund their retirement healthcare needs healthcare coverage in general. The
Source: PricewaterhouseCoopers Health Research Institute, Tailoring the approach: Employer attitudes and healthcare
strategies address distinct issues, 2007
PricewaterhouseCoopers View winter 08 1
20. Democrats would bring retirees into the sys- their own, affordable policies without help individual coverage more attractive and
tem either by expanding existing programs, from employers. This approach weakens begin to disentangle health insurance
by prepurchasing retiree healthcare cover- the connection between insurance from employment.
age, or by using health markets to increase and employment.
access. The Republicans favor tax incen- Under the Republican plan, people
tives through the expansion or modification The Republican plans extend the approach who purchase coverage costing less
of health savings accounts (HSAs). that President George W. Bush proposed than the deduction amounts would still
in his fiscal year 2008 budget: Contribu- receive the full value of the deduction,
Tax reformers and market makers tions to employer-sponsored insurance are which could influence individuals to shop
included in wages and therefore subject for the most basic coverage. However,
Instead of employer or individual mandates,
to income and payroll taxes. In exchange, the proposal would offer few incentives to
Republicans generally support changes
the president’s proposal would provide low-income earners who have no or little
to tax policy to stimulate a more robust
a standard deduction of $7,500 for all tax income liability. The administration
individual insurance market. Their theory
insured individuals and $15,000 for insured estimated that its proposal would reduce
is that with attractive rates and policies,
families. By eliminating the tax advantages the number of uninsured by 3 million.
individual consumers—especially those
associated with employer-sponsored insur- Critics, however, argue that employer-pur-
who are currently uninsured—can secure
ance, the president’s proposal would make chased insurance might continue to enjoy
an advantage over individually purchased
policies because of more favorable pricing
based on employer purchasing power.
Republicans favor expanding HSAs,
which let individuals earmark tax-
exempt contributions for healthcare.
By increasing contribution limits, they
hope to entice more individuals to
purchase insurance. Some also favor
doing away with high-deductible
requirements for HSAs, which would
also make the plans more attractive.
Opponents say the impact of such HSA
changes would likely be modest, based
on how changes have been received
since their inception a few years ago.
The HSA-eligible, high-deductible-health-
plan option has attracted about 4.5 million
Americans, about one-fourth of whom
previously were uninsured.4 However,
only about half of those with eligible
plans have actually opened HSAs.5
4 America’s Health Insurance Plans Center for Policy and
Research: “January 2007 Census Shows 4.5 Million People
Covered by HSA/High-Deductible Health Plans,” April 2007.
5 US Government Accountability Office, Consumer-Directed
Health Plans, Early Enrollee Experiences with Health Savings
Accounts and Eligible Health Plans, report to the Hon. Max
Baucus (D-Mont.), August 9, 2006. http://www.gao.gov/new.
items/d06798.pdf.
18 PricewaterhouseCoopers View winter 08
21. The individual market for health insurance There is emerging evidence to support regulations concerning employers—rules
has not grown during the past three years, this push, and some of the employers that and regulations designed to help expand
and the percent of Americans in high- have instituted wellness and prevention coverage for working Americans. Repub-
deductible health plans dropped in 2006, programs have seen a clear return on their lican candidates will frame the discussion
according to the Commonwealth Fund. investment in terms of improved worker around modifications to the tax code and
productivity or reduced absenteeism. reduced regulation of the insurance indus-
In keeping with the vision of expanded Employers are encouraged to create incen- try to de-emphasize the employer’s role in
individual markets, Republicans also favor tives for healthy behavior that may prevent favor of market forces.
permitting cross-state selling of insurance. chronic disease. That means programs to
The reduced regulations would create promote screenings, smoking cessation, Both parties are likely to promote wellness
national health insurance markets in which weight loss, and regular exercise. But there strategies designed to encourage healthy
individuals could purchase insurance plans are no quick fixes: Even the best employer lifestyles and to manage the epidemic
from anywhere in the nation. Under current programs are ineffective unless people of chronic disease. In the end, however,
regulations, insurance products may be commit to changing their behavior. commitment by business leaders and col-
sold within a state only if the product is laborative public-private partnerships most
approved by that state’s insurance com- The debate continues likely will help enhance productivity, reduce
missioner and if it abides by the individual the number of uninsured, quell the growing
As the presidential campaign season
state’s mandates. The Republicans pro- burden of healthcare costs, and lead to a
continues, employers can expect to see
pose replacing 50 different sets of state more healthy community.
increased attention paid to the health-
regulations with a single national standard. care debate and to the employer’s role in Sandy Lutz is managing director, Benjamin Isgur is
workers’ health. Democratic candidates, assistant director, and Jeffrey Gartland is a research
Reining in costs who focus on decreasing the number of analyst with the PricewaterhouseCoopers Health
Proposed mandates and tax policy changes uninsured, will speak about new rules and Research Institute.
focus principally on the issue of expanding
coverage for the uninsured. But controlling
skyrocketing healthcare costs is another
important priority—particularly for employ- Employer impacts
ers. To help control costs, Republicans and
Democrats alike urge an increased focus on
The good, the bad, the unknown
the twin pillars of wellness and prevention,
At this stage of the election, it’s still too early to assess the bottom-line impact of health-
yet the parties have yet to outline significant
care reform on employers. However, no matter who is elected, employers will be affected.
policies promoting this agenda and the
Here are a few of the potential benefits and risks associated with healthcare reform that
employer’s expanded role.
you might want to keep on your radar screen.
The consensus is that while tradition-
Potentially positive outcomes Potentially negative outcomes
ally, governments—not employers—have
been held responsible for a population’s • Fewer uninsured people in the health- • Coverage mandates could lead to
health, government alone cannot pre- care system may reduce both cost shift- higher costs and/or penalties.
vent the spread of chronic disease. The ing and overall premium costs.
• Tax credits and deductions that encour-
workplace is seen as an important focal
• Tax credits to purchase insurance may age workers to buy individual policies
point for successful prevention strategies,
increase attractiveness for recruitment may take away what some employers
and employers are seen as being able to
and retention at smaller firms. consider to be a key retention tool.
influence individual behavior by providing
a supportive environment and leveraging • More government spending on wellness
existing infrastructure to offer low-cost but and prevention could benefit employee
effective interventions. productivity.
PricewaterhouseCoopers View winter 08 19
