"[L]arge employers increasingly have bypassed traditional health insurance for their workers, opting instead to assume the financial risk of enrollees' medical care through self-insurance. Because self-insurance arrangements may offer advantages -- such as lower costs, exemption from most state insurance regulation and greater flexibility in benefit design -- they are especially attractive to large firms with enough employees to spread risk adequately to avoid the financial fallout from potentially catastrophic medical costs of some employees. Recently, with rising health care costs and changing market dynamics, more small firms -- 100 or fewer workers -- are interested in self-insuring health benefits"

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