Despite a rare reprieve during the COVID-19 pandemic, health care spending continues to go up, up, up. Employers are bracing for another round of hikes this renewal season, while Mercer is forecasting a 5.6% increase in per-employee health care costs in 2023. With inflation taking a heavy toll on employees' pocketbooks, employers will have some hard choices when deciding how to absorb the increase in costs. In fact, Mercer's estimate takes into account expected cost-containment measures, without which health plan cost increases would be closer to 7%. Related: 7 ways employers are taking action to tackle high health care costs But not all employers will have the same struggles. Those who have invested heavily in strategies such as preventive wellness, primary care and direct-contracting, among others, could feel less pain than their counterparts. Even so, factors outside of the employer's control remain, such as where they are located. Recently, Kaiser Family Foundation updated its average annual percent growth in health care expenditures by state. This study includes research from 1991 to 2020. Between 2019 and 2020, spending increased by an average of 5.75%, with some states seeing more painful increases than others. Check out the slideshow above to see which states have a handle on health care spending, and which have the most work to do.