As strong as NHE growth has been, employers’ healthcare expenses have been growing even faster. Employers’ group health plan costs are expected to jump 9 percent in 2027, the largest annual increase since 2011. In the last 20 years, employer healthcare costs have increased by over 400 percent, or over 2.5 times the rate of inflation. The proliferation of GLP-1s and specialty drugs, a surge in behavioral health utilization, and providers’ use of AI tools to capture more charges are cited among the key drivers of cost growth. 
 
Employers are struggling to find deflationary levers to pull. They can increase employee premiums, as two thirds of large employers are doing, or they can reduce benefit generosity by cutting network size, restricting GLP-1 utilization, and raising employee cost-sharing levels. However, none of these moves change the economics of employer-sponsored care more than incrementally. The most intriguing innovation: the 31 percent of employers experimenting with non-traditional plan designs, like employer-provider partnerships and high-performance networks. Because employers are some of the most-powerful and least-satisfied forces in healthcare, it feels inevitable that eventually (one of these years or decades) the dam will break, and we shift to a new payment model.