Professionals responsible for buying employer-sponsored health insurance at their organizations could handle it if the next president and Congress were to be successful in getting a public option added to the list of choices on the Affordable Care Act exchanges – but a complete scrapping to be replaced by Medicare for All, not so much, according to the latest survey by the National Alliance of Healthcare Purchaser Coalitions.

Ninety purchasers for employers that are members of coalitions affiliated with the National Alliance were polled, and just over a third (34 percent) say that a Medicare public option could be a helpful reform for their employer health and well-being strategies, while another 29 percent are neutral.

However, more than 52 percent say that "Medicare for All" would be somewhat or very hurtful.

As for other potential reforms, most of the respondents (84 percent) say that hospital price transparency could be helpful to their strategies and 46 percent say it could be very helpful. Similarly, 72 percent say that rate regulation could be helpful and 44 percent say it could be very helpful.

"We've reached the tipping point of what employers, their employees and family members can bear for health care costs," says Michael Thompson, National Alliance president and CEO. "While government action is not the first choice, if market dynamics don't change it may be our only choice."

Purchasers were also asked which market forces significantly threaten the affordability of employer-sponsored plans, and by far the greatest threat is the price of drugs (94.38 percent).

Other threats include hospital prices (80 percent); industry consolidation (51.16 percent); lack of transparency (67.05 percent); intermediary conflicts of interest (39.08 percent); and surprise medical bills (37.08 percent).

What's needed to create a more sustainable health system? Purchasers' top responses include clear and consistent pricing from hospitals and providers; better aligning incentives for healthcare providers; increasing quality Centers of Excellence at the local level; transparency in pricing and quality indicators; reduction in fraud, waste and errors; and elimination of pharmacy rebates.

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What health care reforms would purchaser coalitions like to see?

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