Employer-Paid

"Low and middle-income workers rely on those other forms of coverage, because they can't rely on access to employer coverage as companies outsource certain functions to contractors or hire more employees in roles that aren't eligible for benefits," said Dr. Sumit Agarwal, an assistant professor at the University of Michigan Medical School and School of Public Health.

"If the first obligation of a health care system is to take care of the sick, we are failing that test," said Dr. Drew Altman, founding president and CEO of KFF.

The hospital giant's chief financial officer told investors that consumer sentiment is also affecting collections.

Thatch, a company that supports the arrangements formerly known as ICHRAs, has attracted a list of backers that includes ADP.

Trust is built over time, and payroll is one of the clearest places where employees see whether that trust is deserved.

"People are worried that it is the opening salvo into promoting junk plans that don't meet the ACA requirements," said Katie Keith, director of the Center for Health Policy and the Law at the Georgetown University Law Center.