Ingram's June 2026

Five Questions to Ask Before Your Next Renewal

enrolled dependents face a different actuarial risk profile than their counter parts in states with longer, more stable expansion histories. “As Medicaid eligibility and payment rules tighten over the next several years, hospitals will see an increase in unin sured patients and non-reimbursable costs. Those costs will have to be recouped somewhere, and it is reasonable to assume commer cial insurance rates will rise.” — Mike Bukaty , CEO, Bukaty Companies, Leawood Bukaty’s read is instructive precisely because it’s measured rather than alarm ist: the cost shift isn’t a current crisis for most area employers; it’s a com ing one—which means there’s still a window for employers to model their exposure before it shows up uninvited on a renewal invoice. How any of this translates to a specific employer’s plan depends heavily on workforce composi tion, geographic footprint, and existing plan structure—which is precisely the question every employer should be put ting to their benefits adviser before the next renewal cycle, not after it. Inside Pricing Power The second structural driver operates closer to home and has been accumulat ing for years. Hospital and health system consolidation in concentrated regional markets has created provider entities with pricing leverage that most employ ers—and many insurers—cannot effec tively counter. The data on this relationship is not ambiguous. A KFF analysis found that as of 2023, one or two health systems provided all inpatient commercial hos pital care in approximately half of U.S. metropolitan areas. Federal health data has documented that horizontal hospital mergers in concentrated markets can raise hospital prices anywhere from 6-65 percent. Physician-practice acquisitions by hospital systems have been linked to average price increases of 14 percent for those services. A 2025 National Bureau

of Economic Research study examining anesthesia provider rollups found that once a single entity achieved dominance in a market, prices paid by employer sponsored plans rose 18 percent within six months of the consolidation. The mechanism is straightforward: when a single integrated system owns the dominant hospital, the dominant physician group, the dominant imaging facilities, and the dominant ambulatory surgery centers in a given corridor, com mercial insurers face a binary choice at the negotiating table—accept the system’s price demands or exclude the system from their network entirely. In concentrated markets, exclusion is rarely viable. So rates rise, and those rates flow directly into the premiums that employers pay. For Kansas City employers, this is not a theoretical concern. The metro mar ket is served by major integrated health systems with significant regional market share across both Missouri and Kansas. The practical consequence is that even a well-managed, fully-insured employer plan has limited protection against the underlying price structure—because that price structure was set in negotiations between the insurer and the health sys tem, in a room the employer was never invited to enter. This is where plan structure mat ters in ways most mid-market employers haven’t fully considered. Employers on self-funded plans have a fundamentally different relationship to the pricing data than those on fully insured arrange ments. They have the contractual stand ing to demand transparency into what their plan is actually paying for specific services at specific facilities. Bukaty’s point is a useful corrective to the way this conversation is often framed. The choice isn’t a binary leap from fully-insured to fully self-funded— it’s a spectrum, and there are intermedi ate structures, including level-funding and captive arrangements, that let an employer dial in exactly how much risk and visibility it wants to take on. It involves a risk-tolerance conversation that most employers have never been walked through. The price-transparency tools that could change this equation are improving,

Whether your organization is fully insured, self-funded, or somewhere in between, these are the questions that separate employers who manage their health plan strategically from those who simply absorb whatever the market presents. 1. Are you receiving compensa tion—in any form—from the carri ers or plans you’re recommending to us? Traditional commissions and override payments can create incen tives that have nothing to do with what’s best for your plan. 2. Have you modeled what our plan would look like under a differ ent funding structure—level-fund ed, self-insured with stop-loss, or a captive arrangement—and if not, why not? The decision isn’t binary, and it starts with a risk-tolerance con versation, not a product pitch. 3. What is our plan actually pay ing for high-volume services at the specific facilities our employees use—and how does that compare to other providers in the market? Price transparency rules now make this data obtainable; most employers have never asked for it. 4. How much of our medical trend is attributable to provider price increases versus utilization changes? These have different causes and dif ferent remedies—you can’t manage what you can’t disaggregate. 5. How is our plan positioned for the Medicaid enrollment changes coming through 2026 and 2027— and has anyone modeled the cost shift exposure for our specific workforce? The exposure depends on workforce composition and geog raphy, and most employers have never had this analysis run.

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I ngr am ’ s

Kansas City’s Business Media

June 2026