"I wouldn't expect it to happen overnight," says Paul Fronstin, director of health research at the nonpartisan Employee Benefit Research Institute. "If you look at the movement to managed care, or the movement away from defined benefit pension plans -- none of those things happened overnight. Somebody had to be first, and then it snowballed from there, but it played out over years, not months."
Fronstin says the employer incentive to drop coverage is not quite as clear-cut as it appears. Even in this difficult economy, companies are concerned about the recruitment and retention of good employees. And then there is the fact that companies offer coverage today, with no law to compel them to do it, and no fine to pay if they drop it. Why would they stop in 2014?
Here's the major reason: By that time the exchanges will be up and running, and workers who lose their coverage will be able to buy government-subsidized coverage. Employers who drop workers' coverage won't be throwing them into the cold as would be the case today.
The bottom line is that the new system appears designed to push more and more people into the exchanges, with more and more people receiving health coverage subsidized by the government. For the cynical, it might even appear that is what Obama and his Democratic allies wanted all along. Remember that Obama said during a January 2008 debate, "If I were designing a system from scratch, I would set up a single-payer system."
He couldn't pass a single-payer system, or even a public-option system, even when he had filibuster-proof majorities in Congress. But he could enact a system that will take a slower route in that direction.
It's no surprise that the president isn't now solemnly promising the American people that "if you like your health care plan, you'll be able to keep your health care plan, period." But it seems likely that Americans will hear those words again. Perhaps in 2012 -- in Republican attack ads.