Small businesses can't solve a healthcare cost problem they didn't create

I was reading an article in EBN this morning about the growing pressure small and midsized businesses are facing from healthcare costs, and one statistic really jumped out at me.

54% of SMBs offering group coverage are reportedly facing double-digit premium increases for 2027. And 73% of those businesses are considering dropping the benefit altogether.

That should make us stop and think.

The conventional response is to find a better broker, redesign the plan, increase deductibles, or shop carriers. Those strategies may all have a place. But I think we’re missing the bigger issue.

We’re asking small businesses to solve a healthcare cost problem they didn’t create and have very little ability to control.

If the underlying cost of healthcare continues to rise, better plan shopping doesn’t fundamentally solve the problem. It often just determines who absorbs more of the cost — employer or employee. That’s why I think ICHRA is interesting, but perhaps for a different reason than how it’s often marketed.

ICHRA doesn’t magically make healthcare cheaper. It can change the employer’s role from absorbing an increasingly unpredictable insurance cost to making a defined contribution while giving employees more choice.

In other words, it introduces something employers desperately need right now: predictability.

Maybe the bigger question isn’t how we help small businesses buy health insurance more efficiently. Maybe it’s whether employers should be in the business of buying health insurance at all.

That feels like a much more interesting conversation.