This one presented a real dilemma — and a major irritant — for employers that pondered switching health plans to save money. The health-reform law stipulated that if you did switch, you had to pick a new plan that provided added services, including preventive care — meaning, of course, that your costs would go up.

A White House official told Bloomberg News that President Obama is considering scrapping the added-service rule and allowing “grandfathering”: permitting businesses with existing health plans to switch as long as the move doesn’t result in lower levels of benefits for employees. A ruling on the idea could come sooner rather than later, as the White House wants to look more business-friendly at elections time.

Follows two other rulings
The possibility of the ruling follows two other business-friendly changes to the initial health law:

• Groups and companies were exempted from a requirement that would raise minimum annual benefits for low-cost health plans used to cover about 1 million part-time or low-wage workers — a change that got a lot of support from the likes of fast-food giant McDonald’s Corp.
• A change in tax-reporting rules got delayed by a year to give businesses a chance to adjust.

According to a just-released survey by the National Business Group on Health and Towers Watson, your peers plan to take some money-saving, and some radical, steps this year:

Savings Strategy #1: Charge more to cover spouses

This step just may prompt more hubbies and wives to use their own employers’ plans.

The more moderate option: Conduct an eligibility audit. Most companies find they have folks on their plan who don’t belong there. Removing ’em will bring costs down.

Savings Strategy #2: Offer financial rewards or penalties based on the results of specific lab tests

Work to control cholesterol, diabetes and blood pressure and be rewarded; don’t and pay the price – literally.

The more moderate option: Simply offering the steps that improve those test results, like smoking quit lines and Weight Watchers meetings, can help.

Savings Strategy #3: Exclude overweight employees from the most desirable health plans

No one wants to be on the outside looking in — this may spur at least some folks to do what it takes to get to the best offering.

The more moderate option: Everyone can use every plan, but overweight folks pay a tiered fee based on body mass index, refundable when they get the number down.

The U.S. Chamber of Commerce and various unions have signed off on their opposition to the proposed 40% excise tax on so-called “Cadillac” health plans — those whose premiums exceed $8,500 for individuals and $23,000 for families.

Under the proposal, the tax would be levied on insurance companies that offer such plans and on employers who self-insure. The Congressional Budget Office says the tax would provide $149 billion in revenue by 2019. Further, proponents of the tax say it will help curb healthcare costs by forcing employees to be more aware of their medical spending and by discouraging insurance companies and employers from offering lavish plans.

Employers and unions firmly oppose the plan, for different reasons:

• Unions contend their workers have given up wage increases in return for better benefits. Labor leaders warn that the excise tax will force cuts in benefits or pass-along cost increases to workers. In an e-mail to members, the Teamsters said the tax would fall on one-third of Americans in a decade, and the average affected household would pay $7,600 more in taxes between 2013 and 2019. Further, as health-plan costs would almost certainly rise in the coming years, the tax would hit more and more people whose premiums would grow into the “Cadillac” category.
• Employer groups note that about 160 million people receive health coverage through employers that self-insure. The Chamber of Commerce argues that those employers will be hit with the cost burden, likely resulting in reduced worker benefits to avoid the tax or reduced wages to make up for the tax.

Both sides also argue the tax would be a killer in high-cost areas such as California or the Northeast, where health plans tend to be more expensive.