Exchange glitches and government shutdown politics aside, it turns out that the biggest concern that America’s workers have about the impact of the Affordable Care Act is still very much cost — direct, rising prices for health care insurance, over the next few years.

That’s the consensus of a survey released Oct. 22 by the National Business Group on Health, representing more than 375 large employers across the country. Of the 1,500 or so regular, front-line, employer-insured workers surveyed just before the Oct. 1 debut of the exchanges, more than half say they’re convinced that their premiums will increase significantly in the next year, and even more see increases over the next three years.

Helen Darling, NBGH president and CEO, says about a third (32%) of employees surveyed also believe that the overall quality of their health care benefits will drop as the ACA begins to roll out.

“There is some realism and the understanding that there is no free lunch — people are accustomed to costs always going up, even without the ACA,” Darling says. “You can’t add more things to benefits packages and not have the costs go up.”

As a result, Darling says employers need to be especially prudent in communicating the value of their existing coverage, and also continue to encourage employees become better consumers as more of the financial burden is shifted in their direction.

“We still need to help employees understand the impact of the ACA — the good news is that employees have gained confidence in making their own decisions,” she says. “They do know more than they used to, and they’re better at using comparative research, as these health care decisions are going to be difficult.”

Much like the joking observation made by TV’s Jimmy Kimmel over 'Obamacare' vs. ACA, the survey found that while employees weren’t necessarily familiar with the ACA itself (only 40%), they knew much more about its provisions – 69% were aware of the individual mandate and 63% knew that mid- and large-sized employers were now required to provide insurance.

A survey taken today might show different results, but NBGH’s summertime poll indicated that only 38% of employees were aware of the creation of public health exchanges; however, among those who knew about the private exchanges, approximately two-thirds expressed interest in having more shopping choices available for better rates and services.

Employees also demonstrated that they understand the costs and even potential dangers posed by the overuse of health care services — three-quarters say they would follow a doctor’s recommendations and use over-the-counter meds to treat a sinus infection, versus antibiotics.

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