8 in 10 employers say health care costs affect their ability to remain competitive.

The outlook for the benefits industry looks anything but certain.

"Employers are highly focused on supporting the mental health of their employees, especially as they look to retain and engage talent," says Erin Terkoski Young, senior director for WTW's Health, Equity & Well-being practice.

The current number of deals is very close to the five-year average with Acrisure leading all buyers at 80 transactions year-to-date, according to OPTIS.

Since the new rule was proposed earlier this month, several business groups have sent letters urging the agency to offer an extension, saying the DOL underestimated the time companies need to review the rule and estimate its financial impact on their businesses.

"Employers are already concerned about what they pay for health premiums, but this could be the calm before the storm, as recent inflation suggests that larger increases are imminent," says Drew Altman, president and CEO of KFF.

Nearly 60% of employees accepting an HRA to fund their marketplace health insurance are between 18 and 44.

The rate of patients who left without being seen increased from 1.1% in 2017 to 2.1% by the end of 2021.