How Health Policy Affects Self-Funded Employers: What Employers Need to Know

When employers think about rising healthcare costs, they often focus on claims, prescription drugs, provider prices and their next renewal. But some of the factors shaping those costs begin in state legislatures, Congress, and regulatory agencies.

Health policy can influence what employers pay for healthcare, what data they can access, how healthcare prices are disclosed, and what options are available to employees.

For self-funded employers, understanding those policy changes is increasingly important.

That was the focus of The Alliance’s recent health policy webinar, featuring David Specht-Boardman, executive director of Advancing Free Market Healthcare and Brett Jackson, president and CEO of the Economic Alliance for Michigan.

Here are some of the key takeaways.

You can also watch the webinar here:

Why Does Health Policy Matter to Self-Funded Employers?

Changes involving hospital prices, prescription drug costs, healthcare data, access to care, and health plan requirements can affect self-funded employers’ healthcare spending and the choices available to employees and their families.

Even when a policy doesn’t directly apply to a particular employer or health plan, it can still change the broader healthcare market.

That makes health policy another factor self-funded employers should consider alongside claims data, network performance, benefit design and provider strategy.

David put it simply, “Staying informed helps employers prepare rather than react.”

Price Transparency and Access to Healthcare Data Remain Key Issues

One of the most important policy discussions for employers is access to meaningful healthcare pricing and claims data.

Several federal proposals discussed during the webinar could expand or strengthen price transparency requirements and employers’ access to healthcare information. The panel highlighted the importance of ensuring employers can access the data associated with their own health plans without unnecessary administrative barriers.

This matters because employers can’t effectively manage healthcare spending if they don’t have access to the information needed to understand what they’re purchasing. Claims and pricing data can help plan sponsors evaluate utilization, identify cost drivers, compare prices, and make more informed decisions about their health benefits.

The broader takeaway is simple: data can give employers more control over their healthcare purchasing decisions.

PBM Reform Could Change How Employers Purchase Pharmacy Benefits

Prescription drug costs were another major focus of the discussion.

The speakers highlighted recent federal developments involving pharmacy benefit managers (PBMs), including provisions in the Consolidated Appropriations Act of 2026, Department of Labor activity, and Federal Trade Commission actions involving major PBMs. Implementation is expected to continue into 2027 and beyond.

For self-funded employers, these changes could create opportunities to take a closer look at how pharmacy benefits are purchased and how contracts are structured.

But policy changes alone don’t reduce an employer’s healthcare costs.

Employers may need to understand the new information and protections available to them, evaluate their current arrangements, and determine how to use those changes when negotiating or purchasing pharmacy benefits.

David emphasized, “Policy can create new opportunities, but employers have to act on them.”

Healthcare Policy Doesn’t Stop at the Federal Level

Healthcare policy is shaped at both the federal and state levels, and the two often interact.

Federal policies can establish a baseline that states build upon. Federal law can also limit what states can regulate. In other situations, states can experiment with policies before similar ideas are considered nationally.

Wisconsin provides several examples.

David shared Wisconsin’s work around hospital price transparency, PBM reform, direct primary care and healthcare data access.

Brett discussed how federal laws such as ERISA can interact with state healthcare legislation, creating important considerations for employers and policymakers.

For employers, this means monitoring only federal healthcare policy isn’t enough. State policy matters, especially for employers operating in Wisconsin or across multiple states.

What Health Policy Issues Should Employers Watch?

While the policy landscape continues to evolve, several issues discussed during the webinar are likely to remain important to employers:

• Healthcare price transparency
• PBM reform and prescription drug pricing
• Hospital pricing and healthcare consolidation
• Employer access to claims data
• Direct primary care and other alternative care models
• Healthcare applications of artificial intelligence (AI)
• Competition and consumer protection in healthcare

The specific legislation and regulations will change over time, but the underlying questions remain consistent:

• Can employers understand what they are paying for?
• Can they compare options?
• Can they access their own data?
• Do they have meaningful opportunities to make better purchasing decisions?

How Can Employers Influence Health Policy?

1. Stay Informed

Monitor the policy developments that could affect your health plan. Employers can also rely on trusted organizations and advisors to help interpret complex legislative and regulatory changes.

2. Understand How Policy Affects Your Plan

When a new law or regulation is proposed or enacted, ask “What does this mean for our health plan, our employees, and our healthcare purchasing strategy?”

Don’t stop at understanding the policy. Consider what action, if any, your organization should take.

3. Use Your Data

Policy changes can create new opportunities, but employers need information to take advantage of them. Understanding your claims, pricing, and pharmacy data can help you identify where policy changes may create opportunities for your organization.

4. Share Your Experience

Employers have something policymakers need: real-world experience.

If a healthcare policy is affecting your organization, employees or families, sharing that experience can help policymakers understand the practical consequences of their decisions.

And employers don’t have to navigate that process alone. Organizations such as The Alliance, the National Alliance of Healthcare Purchaser Coalitions, and Advancing Free Market Healthcare can help employers stay informed and engage in health policy discussions.

Employer Voices Matter in Health Policy

One of the strongest themes from the webinar was that employers should not assume someone else is representing their interests.

Decisions made in Washington and state capitals can influence the prices employers pay, the information they can access, and the choices available to their employees.

Working together, employers can help advance policies that promote greater transparency, competition, accountability, and value in healthcare.

Interested in learning more about health policy and self-funding?

Connect with The Alliance to explore resources, upcoming events and opportunities to engage in efforts focused on making healthcare more affordable and effective for employers and their employees.