[jaredmck]

Large employer insurance plans are often self-funded, meaning that the insurance company charges administration fees but does not truly insure the plan financially.

Certainly small employers are worse at negotiating health care plans, but I'm not sure how much leverage they could possibly have in negotiations given economies of scale and switching costs.

(in a past life, I worked for a benefits consulting firm which specialized in union plans - one positive of how these plans operated was that they disclosed their benefits costs as $/hr rate per member.)