The exchanges, which were devised under the health care overhaul, may offer an alternative for their workers. These exchanges aim to provide a marketplace for people to buy insurance that can be subsidized by the government based on income levels.

A large majority of employers in both studies said they expect to continue offering benefits once the exchanges start. But former insurance executive Bob Laszewski said he was surprised that as many as 8 or 9 percent of companies already expect to drop coverage a couple of years before the exchanges start.

Such a move comes with potential payroll-tax headaches and could subject firms to fines. It also would give their employees a steep compensation cut if companies don't raise pay in exchange for ending coverage.

"Dropping coverage is going to be very difficult for these (companies) to do," said Laszewski, a consultant who was not involved with the studies.

Towers Watson's Randall Abbott said the survey results should be seen as a snapshot of how companies are thinking now. They can't be viewed as a final decision because there are still many unresolved variables. No one knows what the exchanges will be like or whether consumers will accept them, and companies may change their thinking once they learn more about the overhaul.

The health care overhaul also faces court challenges, and President Obama is up for re-election next year, two more variables that could shape what happens in 2014.

Update from BenefitsPro:

As for retirees, more than half of employers (54 percent) that offer health care benefits plan to discontinue them for both pre-65 and post-65 retirees, according to Towers Watson.

Almost 90 percent of employers are also taking steps to control their costs and avoid the impact of health care reform's excise tax, which 56 percent believe they'll trigger by 2018.

Still, employers appear to be committed to offering health care plans in 2012, and more than three-quarters believe that health care benefits will continue to be a key component of their overall employee value proposition beyond 2014.

"With so much still unknown regarding both the short- and long-term impact of health care reform, most employers will not make wholesale changes to employer-sponsored health plans in 2012," said Ron Fontanetta, senior health care consulting leader at Towers Watson. "However, a small group of employers is driving more fundamental change in 2012 by using account-based platform designs, aggressively positioning incentives and rethinking subsidization levels."

Specifically, between now and 2014, employers are planning or considering the following actions:

• Increase offering of account-based health plans (ABHP)² (17% intend to add this plan design in 2013 or 2014, which would result in nearly three in four [74%] employers offering an ABHP)
• Use value-based benefit designs³ (49 percent)
• Increase use of preferred networks (58 percent)

Additionally, employers are considering further strategy changes in 2014 and 2015:

• Substantially reduce the health care benefit value of active employees (47 percent)
• Reduce employee health care contributions for lower-paid workers (57 percent)

2012 Health Care Costs: A Snapshot

The average reported annual cost of medical and pharmacy coverage is $11,204 per employee for active coverage. Roughly two-thirds of employers (66%) will increase employees' share-of-premium contributions for single-only coverage for 2012, and 73% will increase them for employees with dependent coverage.

Cost shifting is expected to continue well beyond 2012. According to the survey, by 2013 or 2014, many employers are considering significantly reducing their subsidization of coverage for spouses and dependents (23 percent), and using spousal waivers and surcharges when other coverage is available (19 percent). Today, only 5 percent of employers have, or plan to encourage, performance-based payments⁴ to providers based on the health status of plan participants by 2012, but an additional 26 percent are considering the implementation of this strategy for 2013 or 2014.

"It is clear from our research that employers remain committed to providing employer-sponsored benefits for the foreseeable future," said Randall Abbott, senior health care consulting leader at Towers Watson. "2012 will ultimately be a defining year— the year some employers head down a path of bold and decisive actions, while others will wait and see. Whether choosing to pay or play, employers will need a strategic view for the future."

Other interesting data points emerging from the survey include:

• Seven out of 10 employers (70 percent) expect to lose grandfathered status by 2012.⁵
• More than half (57 percent) of employers are considering rewarding or penalizing their employees based on biometric outcomes (versus 8 percent today).
• One in three employers (32 percent) don't offer health care coverage to their part-time employees.
• More than four in 10 (44 percent) employers currently use or are considering using social media tools to impact employee health and well-being (versus 14 percent  today), and 26 percent currently support or are considering supporting employee health management with the use of online games (versus 9 percent today).

¹ Excise tax: According to the PPACA, the federal government will impose an excise tax of 40 percent on insurers of employer-sponsored health plans, including self-insured employers, with an aggregate value of more than $10,200 for individual coverage and $27,500 for family coverage.

² Account-based health plans: A plan with a deductible offered together with a personal account (health savings account or health reimbursement arrangement) that can be used to pay a portion of the medical expense not paid by the plan. ABHPs typically include decision support tools that help consumers better manage their health, health care and medical spending

³ Value-based design: Explicit use of plan incentives to encourage enrollee adoption and appropriate use of high-value services, healthy lifestyles and use of high-performance providers that adhere to evidence-based treatment guidelines

⁴ Performance-based payments: Health care providers under this arrangement are rewarded for meeting preestablished target metrics for cost-effective and efficient delivery of health care services.

⁵ Grandfathered status: A grandfathered plan is a group health plan that was in existence on the date of enactment of the PPACA (March 23, 2010). These plans are currently exempt from complying with some parts of the health reform law, so long as the plan does not make significant changes to existing policy.