> Employers are welcome to purchase healthcare.gov plans that are not allowed to price based on pre existing conditions:

Which are stupid expensive for anyone much above the poverty level.

> If an employer wants to self insure and restrict their risk pool to only their employees, then they have to pay for it

A 250 person company wasn't self insuring or restricting their risk pool to only their employees. They wouldn't be negotiating premiums with an insurance company if they were self insuring.

If they were not restricting their risk pool, then how would a couple kids with cancer affect the company's premiums? The costs would be distributed across a much larger population.

When I was shopping around for health insurance for my businesses, the premiums were the same as what they would have been individually on healthcare.gov. Kaiser has a good report showing the costs are not that different based on firm size:

https://www.kff.org/report-section/ehbs-2020-section-1-cost-...

The cost of healthcare is pretty predictable, and spread over a sufficient population converges to the same numbers. Only option I can think of is people were thinking that the employer reduced their portion of healthcare they were subsidizing, and so people thought premiums were going up since the size of the portion they were expected to pay went up? Most people do not really know to look at box 12 code DD of their W-2 to know what is happening with their healthcare insurance premiums.

Because the premiums even for the larger risk pool can be negotiated with the insurance company. And if you suck at negotiating (like our HR), then you can accept at face value the arguments the insurance company makes about how much you're costing them, and how they'll just drop you if you don't accept higher premiums.

And I'm going to guess that your businesses had very, very few employees? To the point of not being worth negotiating with from the insurance company's perspective?

And Kaiser isn't run like most insurance companies.

Kaiser is short for Kaiser Family Foundation, which compiles nice reports about healthcare in the US. Using their reports does not have anything to do with Kaiser the company. Although their insurance side is similar to any other health insurer.

>And I'm going to guess that your businesses had very, very few employees? To the point of not being worth negotiating with from the insurance company's perspective?

Yes, but that was my point about businesses being able to just buy the health insurance plans available on healthcare.gov. Earlier you mentioned the healthcare.gov plans were:

>Which are stupid expensive for anyone much above the poverty level.

But the data does not support that. Average annual employer sponsored insurance is $7,675 for single PPO coverage in 2019:

https://www.kff.org/report-section/ehbs-2019-summary-of-find...

And average lowest cost monthly gold premium on healthcare.gov is $516 ($6k annual) in 2019:

https://www.kff.org/health-reform/state-indicator/average-ma...

So employers can probably save money going to the healthcare.gov plans, albeit with higher out of pocket maximums probably. But at least a couple kids with cancer would not throw off the premiums.