No matter how the Supreme Court handles President Obama's reform law, the approach to medical insurance will be remade. By Martha Lynn Craver, Associate Editor April 5, 2012 Sweeping changes in health care are on the way, even if the Supreme Court guts President Obama's massive reform law, and even if Republicans win the White House in November.Big employers, looking to hold down costs, are driving the change, along with insurers and health care providers. Medical insurance premiums are up about 6% this year and face a similar increase in 2013. Here are ways companies can trim their costs: • Offer an account-based plan as an option, or even as the only health benefit. Workers use the account to pay medical bills until they meet a high deductible, after which insurance payments kick in. Companies save money because policies with high deductibles have lower premiums. • Put more focus on wellness and prevention by reducing contributions from workers who meet health-related goals or take part in health screenings. Or impose penalties or surcharges on those who don't participate. Advertisement • Widen the copay gap between brand-name drugs and generic equivalents. More companies will turn to a simplified two-tier pharmacy benefit, with a 10% copay for a generic but a 50% charge for the original. That could add up to a difference of $100 or more on some drugs, enough to push more consumers to make the lower-cost choice. Insurers and providers are making changes, too, and are likely to retain them even if the high court nullifies the law. These include allowing children to stay on a parent's policy until they turn 26 and eliminating the lifetime cap on insurance payments.