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An analyst at a company that helps self-funded employer plans buy care directly from health care providers thinks the plans' own costs are mostly under control.
But the analyst says employers and their benefits advisors should watch carefully for signs of health care providers charging employers more to make up for federal Affordable Care Act premium tax credit subsidy cuts.
For employers, "stable numbers today don't guarantee smooth sailing ahead," according to Dr. Rani Aravamudhan, a medical doctor who serves as a vice president at Nomi Health. "ACA market stress could spill over into private commercial markets."
Aravamudhan cited an AFL-CIO forecast that the spillover from ACA premium subsidy cuts could increase premiums for the people with employer-sponsored health coverage by $182 to $485 per employer plan participant per year.
The backdrop: Employee leasing firms, employers and benefits consulting firms have suggested that employer plan costs are up about 7% to 8% this year and could rise as much as 9% in 2026.
But Nomi looked carefully at its own self-insured employer clients and found that, today, their costs are only about 5% higher than in 2025, Aravamudhan reported.
Spending on medical care is up just 1.75% per member per month.
Increased use of GLP-1 agonists like Wegovy and some other types of drugs caused prescription drug spending to increase by 8.64%, but employers knew that increase was coming, Aravamudhan said.
The number of claimants with costs over $100,000 increased by 7.8%, but any increase under 8% is normal, she added.
When Nomi looked at five of the states it serves, it found that the current level of medical cost growth for self-insured employers there ranged from 0.35%, in Florida, up to 6.43%, in New Jersey.
The analysis showed that employers that manage their self-funded plans carefully, they are keeping costs under control, Aravamudhan said.
The future: Employers who want to avoid getting swamped by an ACA subsidy cut spillover effect should watch carefully for early indicators of cut-related market stress, Aravamudhan said.
She suggested that some of the early market stress indicators could include:
◆ New provider network contract disputes.
◆ Rising administrative fees.
◆ "Hidden spread pricing."
"Hidden spread pricing" spread pricing refers to situations in which some players in the health care system take a secret or poorly disclosed slice of what employers think they're sending to other health care system players.
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