Employers are bracing for another year of steep healthcare cost growth, as drug prices, high-cost claims, and hospital prices continue to strain premiums. Even as they respond with increasingly sophisticated purchasing strategies, the latest data from the National Alliance of Healthcare Purchaser Coalitions show that strategy alone isn’t closing the gap — employers also need policies that provide better visibility into claims and stronger accountability across the healthcare system to make meaningful progress.
The National Alliance’s 2026 Pulse of the Purchaser survey offers a national view of how employers are experiencing these pressures, drawing on 408 responses from private and public employers nationwide representing 3.7 million covered lives.
Rising Costs and High Hospital Prices Pressuring Premiums
Employers said they expect healthcare costs to rise an average of nearly 8% before benefit design changes next year, and one in three employers expect an estimated increase of 9% or more.
The pressure is coming from every direction. Per the survey, for the sixth consecutive year, employers named drug prices, high-cost claims, and hospital prices as their top three affordability threats, with nearly 70% citing hospital prices specifically.
Hospital and facility costs already claim the largest share of employer healthcare spending, at roughly 40%. That share climbs even higher once hospital-affiliated professional fees and physician-administered drugs billed through hospital systems are factored in, particularly as hospital consolidation continues to grow. The National Alliance estimates hospital services now account for nearly half of every dollar employers spend on healthcare.
Employers Are Working to Contain Hospital Spending — but Many Lack Needed Data
With hospitals commanding so much of their healthcare dollar, half of employers are already trying to strategically contain costs by encouraging employees to visit higher-value sites of care, using centers of excellence, evaluating networks, reviewing price transparency data, and exploring direct contracting.
But the survey makes clear that this depends on access to data. Roughly one in three employers lack complete claim-level access, and only about three in five are confident they can audit their complete files. Across all 26 hospital and high-cost claim strategies measured, employers with access to their full claims data reported better ability to enact cost containmentstrategies.
Survey is Clear: Employers Overwhelmingly Support Action on Hospital Prices
This clear roadblock further explains the growing support for policy reform. According to the survey, 85% of employers said hospital price transparency reform would be helpful, while support for hospital rate regulation has risen 17% since 2023.
While employers are doing more to manage costs, they cannot solve the affordability problem alone. Everyone supports greater transparency, but transparency needs to be more than a catchphrase; the details matter. The survey makes clear that when employers have access to real, actionable, claims-level data, they are better equipped to make smarter decisions and bring down costs for employees and working families.
Data alone cannot overcome a market in which hospitals, one of the largest drivers of spending, face too little accountability. Employers need further policy action to ensure they have both the information and the leverage necessary to deliver greater value for working families.