Is Congress likely to pass sweeping health care reform legislation in the coming weeks? If it does, what will the impact be on employers and how should employers start to prepare?

Those are some of the questions Business Insurance Editor-at-Large Jerry Geisel posed to Chantel Sheaks, a principal in Buck Consultants L.L.C.'s Washington office. Ms. Sheaks, who has been closely tracking the health care reform legislation since its inception, also follows a wide range of employee benefits-related legislation, regulations and judicial developments.

Q: Congress has been working on health care reform legislation for nearly a year. It is now in the home stretch. The House and Senate each have passed bills. Conferees are trying to resolve differences. Is there good reason to believe a bill will be agreed to by conferees and passed?

I think that at this point there is very good reason to believe something will be passed. I think they're trying to get it before the State of the Union (address by President Barack Obama). That might be a little bit too fast, but I think something will come out by February or by March.

Q: It's clear that the lower-income uninsured will receive health insurance subsidies. What will the impact be on employers?

The things that I think have not been really looked at, and especially in the Senate version, which will add a lot more money, are the new notice, reporting and disclosure requirements. First of all, employers would be required to provide for each new employee and each current employee an explanation of the exchanges, how to get in contact with the exchanges, the fact that if they go into the exchange the employer contribution will not be part of the contribution in the exchange. They have to provide these notices to each employee. Whether they can provide them electronically or they have to provide them hard copy, that's going to be a big debate. And you may think to yourself, “Well that's just one notice,” but it's one more notice.

Q: If 30 million more people have coverage, there should be less cost shifting, or providers that treat individuals without coverage trying to shift those costs to insured plans. Employers should benefit. Is that the full picture?

That's part of it, but you also have offsets of additional requirements that you're putting on employers. And the fear is more people may have coverage, but there may be more people covered under Medicaid. The Medicaid reimbursement rates are not nearly what the hospitals and doctors charge private plans and what they charge employers. So if you start getting more people in programs that don't reimburse (fully), there's still going to be cost shifting. Until there's a level playing field between what Medicare pays, what Medicaid pays and what private insurance pays, there still will be cost movement.

Q: What should employers now be doing as health care reform's likelihood of enactment grows more and more certain?

You need to make sure: Right now the people we've been talking to are the (human resources) people, your benefits managers, maybe your vp of HR. It needs to go up a rung. You need to start briefing your (chief financial officers) and your CEOs to let them know what this really means and let them know what the impact it will have, the financial impact on your plan.

Q: With the work and costs employers face, are there benefits if this legislation becomes law?

One thing that will help employers is that if the exchanges actually work the way they have said they would work in theory, you may have people who, instead of taking COBRA, would go into the individual market and take coverage there. There are some industries that we've seen that people actually want to retire, but they can't retire because they can't get health care coverage...(and now) they could get coverage through the exchange.

Q: The legislation will improve access, but what will it do to costs?

A very simple economic theory: increase access, increase cost. Without cost control, without education, without explaining to people how to use their health care coverage, you'll have increased costs.