By Chris Cordon, Affinity Benefits

If you’re a subcontractor running a company with fewer than 50 employees, you already know that health insurance is one of your biggest line items — second only to payroll. What you may not realize is just how much the deck is stacked against you in the current healthcare market, and how your ASA membership already includes access to a solution that most of your competitors don’t have.

Let’s look at the numbers. Then let’s talk about what you can do about them.

Two Funnels, One Problem

Most small subcontracting firms get their health coverage through one of two channels: an employer-sponsored small group plan or the ACA Marketplace. Both are heading in the same direction — up — but neither is giving you anything in return for the pain.

The ACA Marketplace Funnel. For 2026, ACA Marketplace insurers are proposing a median premium increase of 18%, with the average closer to 20%. That’s the steepest rate hike since 2018. And for enrollees who relied on the enhanced premium tax credits that expired at the end of 2025, the news is even worse — their out-of-pocket premium payments are projected to jump by 114%, more than doubling from an average of $888 annually to $1,904. The factors behind this spike include rising healthcare costs (medical trend alone is running about 8–10% annually), the expiration of federal subsidies, higher prescription drug spending driven by specialty medications like GLP-1s, and the knock-on effect of healthier enrollees dropping coverage, which leaves a sicker, more expensive risk pool behind.

The Small Group Employer Plan Funnel. If you sponsor a group plan for your employees, you’re dealing with a different flavor of the same headache. For companies with 10 to 199 workers, the average family premium hit $26,054 in 2025, up from $16,977 in just 2020 — a 53% surge in five years. Looking ahead to 2026, small group insurers are proposing a median premium increase of 11%, with some requesting hikes above 20%. The underlying medical trend that insurers are baking into 2026 rates is approximately 9%. And just to compound the issue a little more: the small group market is shrinking. Enrollment is declining as healthier groups migrate to self-funded or level-funded arrangements, leaving behind a worsening risk pool that drives costs even higher for everyone who stays. Insurers are openly calling it a “death spiral” in their rate filings. One insurer reported a loss ratio of 116% on its small group book — meaning it paid out $1.16 in claims for every $1.00 in premium collected.

 Why Small Groups Get Hit the Hardest

Large corporations with thousands of employees have the buying power and risk diversification to absorb cost increases and negotiate better rates. A company with 15 or 25 employees doesn’t have that luxury. One serious diagnosis — a cancer case, a premature birth, a chronic condition requiring specialty drugs — can spike your renewal by 20% or more overnight. Your broker delivers the bad news, and your options are brutal: absorb the increase, shift costs to your employees through higher deductibles and contributions, or drop coverage altogether.

The share of small businesses offering health insurance has dropped from 47% in 2000 to just 30% in 2023. That’s not because business owners stopped caring about their people — it’s because the math stopped working.

The ASA Advantage

This is where your ASA membership becomes more than a networking badge. The ASAdvantage Health Plan, built exclusively for ASA members in partnership with Affinity Benefits, operates as a pooled risk health plan with over 20,000 members. That scale changes the math entirely.

Here’s why pooling matters. When you join a pool of 20,000+ lives instead of standing alone with your 15 or 30 employees, the risk of any single high-cost claim is diluted across a much larger population. That’s the fundamental principle of insurance — the larger and more diversified the risk pool, the more predictable and stable the costs become. It’s the same reason large employers enjoy steadier renewals while small groups ride a roller coaster.

The proof is in the performance. While employer-sponsored plans have been increasing 6–7% annually and ACA Marketplace premiums are spiking 18–20%, the ASAdvantage Health Plan has delivered an average of approximately 5% annual increases. That kind of stability isn’t just a nice-to-have — over three to five years, the compounding difference between a 5% and an 11% annual increase is enormous. On a $500,000 annual health spend, the difference adds up to over $100,000 in savings within five years.

What the Plan Actually Looks Like

The ASAdvantage Health Plan isn’t a stripped-down alternative. It covers all essential health benefits required under the ACA, offers nationwide provider networks and includes multiple plan designs to fit different company sizes and budgets. Groups as small as one employee can enroll, and there’s no open enrollment window to wait for — eligible employees can join throughout the coverage year.

Because the plan is structured under ERISA as a self-funded arrangement with stop-loss protection, it avoids many of the state-level mandates and premium taxes that inflate small group premiums. That’s the same structure Fortune 500 companies use — now accessible to a subcontractor with a crew of ten.

The Bottom Line for ASA Members

The healthcare cost trajectory in America isn’t changing anytime soon. Medical trend is running at 8–10%. Specialty drugs are getting more expensive. Provider consolidation is reducing competition and driving up negotiated rates. The small group market is eroding, and the ACA Marketplace is in for a turbulent 2026.

You can’t control any of those forces. But you can control which risk pool your company sits in.

As an ASA member, you’ve already earned a seat at a table that most small businesses can’t access. The ASAdvantage Health Plan gives your company the same pooled risk advantages that large employers take for granted — rate stability, broad networks, and a plan designed specifically for the construction trades.

If you haven’t looked at the ASAdvantage Health Plan yet, now is the time. Visit www.asaonline.com to learn how to get a quote.