Brian Marcotte is president and chief executive officer of the National Business Group on Health in Washington. Mr. Marcotte joined the NBGH, which helps its members control health care costs, improve patient safety and quality of care, earlier this year after more than two decades at Honeywell International Inc., where he was vice president of benefits and compensation. In an interview with Jerry Geisel, editor-at-large, Mr. Marcotte discusses from a large employer perspective the pros and cons of the health care reform law.

Q: More than four years have passed since the passage of the Patient Protection and Affordable Care Act. We know the positive aspects of the health care reform law: Millions of previously uninsured individuals now, due to federal premium subsidies, have gotten health insurance coverage. In fact, more than 8 million people, many of them previously uninsured, have enrolled in plans offered through public exchanges. From an employer perspective, what have been the positive aspects of the law?

A: Providing coverage for more people is a positive. From a large employer perspective, though, I’d classify the ACA as a big distraction over the last four years as employers have tried to understand the cost implications of the employer mandate requirements and how to stay under the Cadillac tax (trigger) as that tax approaches down the road.

Q: Is there something in the law that employers would like lawmakers to change?

A: There are a couple of things. The first one, batted about in Congress, is changing the definition of a full-time employee where we, as employers, would be obligated to provide coverage to employees working an average of 40 hours a week compared to the law’s 30-hour a week requirement. While that legislative change has bipartisan support in the House, it remains to be seen what will happen in the Senate. The other area from an employer perspective would be the elimination of the ACA’s reinsurance fee. This year, the fee is $63 per health care plan enrollee. It purely is a cost-shift to employers to help cover the cost of government premium subsidies provided for coverage in public exchanges.

Q: What is the likelihood that Congress will make any changes to the ACA?

A: If anything has a shot, it is the legislation changing the definition of a full-time employee to those working an average of 40 hours a week. I don’t think it is very likely that we will see any movement on the reinsurance fees. On changing the definition of a full-time employee, if Republicans gain control of the Senate in the November elections, we think there is a better chance of the legislation moving through Congress. But I don’t think there is much confidence that anything beyond that will be done in the short term.

Q: Employers can always terminate their health care plans and give employees money to buy, for example, coverage in public exchanges. Through such an approach, the hassles of offering group health care coverage would be eliminated. So far, though, there has been no widespread employer movement to do so. Why not?

A: You lose the ability to make pretax contributions for health care. That could be a significant cost to employers. In addition, many employees would not be eligible for federal premium subsidies to buy coverage in public exchanges. So, there are hurdles that preclude that from being a reasonable solution for most employers. Still there could be some segments, such as industries with lots of low-wage employees, where it could be an attractive option. But that would not be the case for most employers.

Q: One of the hottest developments in the group health insurance arena is the development of private insurance exchanges. There have been predictions of tremendous growth in private insurance exchange enrollment over the next few years as more employers move to that approach. Do you agree with those predictions?

A: First of all, I probably get more questions about private insurance exchanges from members than any other issue. I think private exchanges are good for the market. They certainly will serve a role. The big question for large employers is what is the value proposition? Can private exchanges demonstrate that they can manage costs and improve care better than what we are now doing? If I am going to consider moving to a private exchange, I need some assurance that it will do a better job than what I am doing today. It is a leap of faith otherwise.

Q: Over the past few years, health care cost increases have been relatively modest. Last year, for example, Mercer L.L.C. found that costs increased at their lowest rate in more than 15 years. How do you explain that?

A: It is all relative. Cost increases for large employers still are several times that of increases in the consumer price index. The slower growth of health care costs has probably been more a function of the economy over the last few years than anything we have done in health care. PricewaterhouseCoopers (L.L.P.) recently projected that costs— before plan design changes — will increase 6.8% in 2015. Our own survey says it will be 7%. After plan design changes, cost increases will be about 5%. This year, after plan design changes, cost went up an average of about 4.5%. That is still twice as much or more as the CPI increase. Health care costs continue, from our perspective, to be the No. 1 challenge for large employers.