With Congress edging closer to historic health care reform legislation that proponents would like to deliver in time for Christmas, critics are hoping Scrooge spreads the word loud and clear about unintended consequences on the worksite market.

One major issue that has flown largely under the radar is a plan calling for universal long-term care (LTC), according to Matt Tassey, a principal of Scribner Insurance and Burwell & Burwell in Portland, Maine, who once chaired the Life and Health Insurance Foundation for Education.

His biggest concern is that “it’s going to trick people into thinking they have [LTC] coverage that is going to be just very insufficient to respond to any needs they have.” The roughly $50 daily benefit for a long-term care facility pales in comparison to the $6,000 monthly cost in Maine, he adds.

But there are other much larger storm clouds forming over all voluntary benefits that are tied to proposed coverage baselines and caps on tax-favored plans.

For example, Linda Havlin, a Chicago-based worldwide partner and national practice leader for Mercer’s health and benefits consulting and intellectual capital areas, cites a provision in the Senate’s Patient Protection and Affordable Care Act for the purpose of determining a 40% nondeductible excise tax on group health insurance coverage deemed overly generous that defines an employee benefit as anything that is employer-sponsored, even if the employee voluntarily elects it and pays the full cost.

The challenge of complying with such a new mandate would be keeping employers within the framework of the law without having to pay a penalty. That could mean that they’re forced to shed some benefit programs, with Havlin suggesting the most tempting targets could be dental and vision programs.

Another concern is if health plans have to provide an actuarial value equivalent to 60% or 70% of cost, that new minimum could become the new industry benchmark in terms of a health benefit and employer contribution. Many employers may consider reducing their plan to the new minimum, “then it’s a buy-up at best or a voluntary benefit for anything beyond that,” according to Havlin.

Employers that currently do not offer plans along with others that may consider dropping their plans may face pressure from employees who try to buy coverage in the new individual market. The good news is the coverage would come without barriers, but it would be generous coverage and more costly than employer coverage.

The larger implication is that employers would have to seriously ponder the unintended consequence of what happens when employees try to buy coverage in the individual insurance market. She says estimates are that it can be anywhere from 10% to 50% higher than comparable employer-sponsored coverage. Some organizations may seek to include an increment in employee compensation for purchasing coverage, but the increase may raise many employee-relations issues about whether it’s enough to purchase coverage, keep pace with health care inflation, or be the same for workers who now have individual or family coverage.

“Ideally,” she says, “the final regulations would exclude voluntary benefits from the definition of employer-sponsored coverage. Otherwise there might be a lot of imagination applied around how to create voluntary programs that are truly independent. Does that take you more toward a direct-to-consumer approach where essentially you would be directing your employees to a market, if you will, to purchase those benefits?”