Will the health insurance exchange markets that will be created in all states in 2014 under the Affordable Care Act primarily be a new channel for employers to purchase coverage, as the Obama administration stresses, or will they be a mechanism for the demise of employer-sponsored health insurance? That was a question posed by Deloitte Center for Health Solutions Executive Director Paul Keckley in an Oct. 9 webinar titled, "State Health Insurance Exchanges: Where Are We and What Lies Ahead?"

Keckley and Paul Lamdin, director of Deloitte Consulting LLP, agreed that, based on simple math, employers would seem to have every reason to drop health insurance coverage for employees and send them to the exchanges. Federal premium tax credit subsidies available to purchase coverage through the exchanges for low- and moderate-income people will total about $4,960 per eligible enrollee, Keckley said.  In contrast, the "shared responsibility" penalty employers with at least 50 employees must pay for not offering affordable coverage is $2,000 per employee, with a deduction for the first 30 employees.

There are clearly other issues for employers to consider, such as whether plans offered on the exchanges are affordable, Lambdin said. For many employees, that will be a crucial issue as well. Most of the subsidies will go to households with incomes below 250 percent of the federal poverty level ($57,625 for a family of four in 2012), Keckley said. Young, healthy people who currently have coverage are likely to face sticker shock if they have to buy exchange policies due to ACA requirements for age rating, "essential health benefits," and out-of-pocket limits, Lambdin said.