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Expand chart
Data: Kaiser Family Foundation; Chart: Axios Visuals

Conventional wisdom holds that big, self-insured companies do a better job controlling health care costs than firms that rely entirely on insurance companies to provide their workers’ coverage. But that’s not true.

Why it matters: Although a handful of big self-insured companies get a lot of attention for their cost-control efforts, the data tell a different story: Self-insured and fully insured companies are equally bad at controlling health care costs.

By the numbers: The average family premium for fully insured firms last year was a whopping $20,627.

  • For larger self-insured firms, it was $20,739.
  • There hasn't been a meaningful difference for the past 20 years.

Self-insured firms would seem to have an advantage because they cut out the middleman.

  • Big self-insured firms can contract directly with providers and limit their networks to only cover lower-cost providers.
  • They can implement the latest payment reforms and wellness programs, and even open up their own clinics.
  • And a few very large companies, including Disney, Safeway and Comcast, have received a lot of attention for their efforts.

Yes, but: Most large insured firms have implemented similar strategies. And they buy insurance from the same companies that administer self-insured plans.

  • Big companies also are often spread across the country and the world, which greatly diminishes their bargaining power. No firm or collection of firms has even close to the leverage Medicare and Medicaid have.

The fundamentals have not changed since I started studying corporate cost-control efforts at MIT decades ago.

  • Most firms live by the same unspoken rule: Do what you can to control health costs without angering the workers you need too much.
  • That’s especially true in strong economies with tighter labor markets.

Other dynamics may be at work, too.

  • Benefits officers do everything they can, but CEOs often serve on the boards of the best and most expensive hospitals and socialize with the leading doctors where they live.
  • Taking on the cost problem would mean reducing the incomes and revenues of people who have their ears.

The bottom line: Even large, self-insured companies with all the advantages still have a poor track record on cost control.

Go deeper

Updated 44 mins ago - Economy & Business

Student debt getting in the way of millennial homeownership

Illustration: Aïda Amer/Axios

Millennial homeownership is on the rise — but student loan debt is still keeping millions of members of America's largest generation from owning a home.

Why it matters: Buying a house remains the No. 1 way to build wealth in the U.S.

Updated 44 mins ago - World

UK government: Kremlin has plan "to install pro-Russian leadership" in Ukraine

British Foreign Secretary Elizabeth Truss. Photo: Gints Ivuskans / AFP via Getty Images

The United Kingdom's Foreign Secretary on Saturday night said the government has "information that indicates the Russian Government is looking to install a pro-Russian leader in Kyiv as it considers whether to invade and occupy Ukraine."

Driving the news: U.S. National Security Council spokeswoman Emily Horne called the intelligence "deeply concerning" in a statement to Axios. The Biden administration has said Russia is actively manufacturing a pretext for invasion and warned that Putin could use joint military exercises in Belarus as cover to invade from the north.

Most teachers are white. Most students aren't.

Expand chart
Data: U.S. Department of Education, National Center for Education Statistics; Chart: Baidi Wang/Axios

The nation's 6.6 million teacher workforce has grown more racially and ethnically diverse over the past three decades — but not nearly fast enough to keep pace with a student population that's nearing majority-minority in public schools, two new reports show.

Why it matters: The disparities are especially acute between Hispanic students and teachers, and in schools with 90% or higher non-white student populations.