Employers have major decisions regarding health care offerings to their employees in the coming months.

Employers have major decisions regarding health care offerings to their employees in the coming months.

Don Antonucci, president of Regence BlueCross BlueShield of Oregon, told a Chamber of Medford/Jackson County Forum audience Monday that the lull between enactment of the Affordable Care Act and the full force of the new law coming in 2014 is over.

Beginning next year, businesses with fewer than 50 employees will have to decide whether to direct their workers to health care exchanges or step up coverage to the act's higher standard, Antonucci said during the monthly gathering at Rogue Valley Country Club.

In the period between the bill becoming law in March 2010 and today, employers generally have taken a wait-and-see approach as the nation moves into its greatest change in the delivery of health care since Medicare and Medicaid were introduced in the 1960s, he said.

Among other variables, employers soon will need to be well-versed in federal poverty standards to determine whether they should offer health care packages or direct workers to health care exchanges.

Most employers, however, have been slow to respond to the monumental reform.

Last year, Antonucci said, eHealth, a major online insurance broker, surveyed 250 businesses.

"What they found was 85 percent of businesses they polled were not doing any planning whatsoever around their expectations for what health care reform would do," he said.

Another poll of small businesses reported 65 percent of the companies said they had done no strategic planning centered around reform.

"I believe this is really representative of a frozen position businesses have been in, sort of a wait and see," Antonucci said. "While waiting for the Supreme Court to weigh in, waiting for the elections, and this was still far enough out that folks were not paying attention. Now you are starting to see businesses really starting to pay attention to what the impact is."

There will be a great deal of scrambling to comply with the new law or face penalties, he said.

"Time is running out," Antonucci said. "The bottom line in most cases is only you are going to determine what your company and employees should do."

There are going to be tremendous subsidies depending on where someone falls in relation to the federal poverty level, he said. Greater access to health care will come for those whose income is four times above the poverty level at a greater cost to those above that income line.

"How do we figure out how to comply with it and leverage it so that it meets the needs of your businesses, employees and their families?" Antonucci said.

Agents and brokers will be able to help employers make those decisions, he said. "And you should engage them early and often."

He said those decisions will boil down to corporate culture and cost.

Companies need to consider whether employees use their present health coverage. Will they desire additional choices or are they happy with their current insurance carrier?

Is health insurance instrumental in keeping current employees with the company?

"When you are competing for employees and looking to move forward, you need to have this in place in order to keep those employees," Antonucci said.

"If it's something really not that valued, then many of the employees in the company would benefit from going to the exchange and getting the subsidies and benefits there. That takes profiling and understanding what your employee base looks like."