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America's 'other' health-care revolution

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Welcome to the system that may soon be coming to a cubicle near you. While headlines have focused on all the rancor surrounding the public health-care exchanges being set up under President Obama's health reform law, businesses across the country are moving to change the coverage they offer employees in ways that are just as dramatic – and may end up having a bigger effect on individuals' lives and the US economy.

From taking tighter control over the health insurance market themselves to pushing decisions and costs down to individuals, businesses are experimenting with a host of new ways to offer health-care coverage, spurred in part by the launch of the Affordable Care Act, but also by the inexorable rise in the cost of medical care in the United States. The moves promise to change a social compact that has existed between employers and employees over health-care coverage for more than a half century.

Already, for instance, several large corporations have announced they are setting up private exchanges like the one the fictitious tool-and-die maker belongs to. More than 1 million workers are set to purchase plans on a private exchange in 2014, and by some estimates, as many as 40 million workers will be enrolled in such private exchanges by 2018.

"Going from 1 million to 40 million in five years is ... hypergrowth," says Rich Birhanzel, managing director of Accenture's Health Administration Services.

Another study by Mercer, a global consulting company that launched a private insurance exchange for large employers in January, predicts that by 2018, nearly 30 percent of the commercial market will be served by private insurance exchanges. The company recently announced that it had signed up 33 employers for its private-exchange platforms for 2014. That includes companies like Petco and the energy firm Kinder Morgan, and others ranging in size from 100 to 30,000 employees.

Aon Hewitt, the nation's largest private health-care exchange, has signed up Walgreens, Sears Holding, and the Darden restaurant group and expects to have more than 600,000 employees covered under plans in its marketplace in 2014.

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