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but unevenly. The Trump administration’s January 2026 health-care pricing initiative includes new requirements for any provid er accepting Medicare or Medicaid to post pricing publicly, and bipartisan legislation in Congress is pushing the same direction. Independent analysis has found compli ance with existing transparency rules to be inconsistent—a 2024 Purchaser Business Group on Health report identified fee categories hidden from employer plan sponsors, raising questions about how much pricing information has been con cealed since transparency requirements first took effect. The tools are being forged. Most KC employers haven’t picked them up yet. The Renewal-Invoice Impact The convergence of these two dynam ics—the Medicaid cost-shift accelerat ing under OBBBA, and hospital pric ing power in concentrated markets—is landing on employer plans at precisely the moment when the underlying cost trend was already at its steepest in 15 years. Mercer’s 2025 national survey of

employer-sponsored plans found that total health benefit cost per employee reached $17,496 in 2025, a 6 percent increase well above the rate of inflation and wage growth. The firm projects a further 6.7 percent increase in 2026, pushing average per-employee cost above $18,500—the steepest sustained increase trajectory since 2010. Employers are responding in the ways available to them within a fully insured framework: 59 percent say they plan to raise deductibles and cost-shar ing in 2026, up from 48 percent the year before. That response shifts costs to employees at the point of care—which, in a tight labor market, is a talent and compensation decision as much as a ben efits-administration one. Health-benefit costs are consuming compensation bud get that would otherwise go to wages, and employees increasingly recognize the trade-off when comparing offers. Yet despite all of this structural pres sure, the conversations area employers are having with their brokers and consul tants may be healthier than the national

narrative suggests. That year-round pos ture is, in itself, a meaningful data point for the feature’s argument. The employ ers most exposed to the structural pres sures described here are the ones who treat the broker relationship as a once a-year transaction. The ones positioned to respond—through plan redesign, net work strategy, or a genuine evaluation of self-funded options—are the ones who’ve made benefits strategy a continuous con versation rather than an annual fire drill. There is no single adjustment that neu tralizes the structural pressures described here. The Medicaid cost shift will con tinue to grow as OBBBA provisions phase in through 2026 and beyond. Hospital market concentration in major metros is not reversing quickly, regardless of what federal antitrust policy does at the mar gins. But employers who understand the architecture—who can see where the costs are actually originating and why— are positioned to make decisions that those still operating on autopilot are not. That difference, compounded over mul tiple renewal cycles, is material.

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