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In this \u201cHow Would You Fix It?\u201d interview, Julie Rovner, KFF Health News\u2019 chief Washington correspondent and host of the What the Health?<\/em> podcast, sat down with Elizabeth Mitchell, the president and CEO of the Purchaser Business Group on Health, which represents many large employers and other institutional buyers of healthcare coverage.<\/p>\n Mitchell noted that employers, which offer coverage to more than 160 million Americans, are a big player in the nation\u2019s healthcare system \u2014 a role they came into because of \u201can accident of history,\u201d she said.<\/p>\n \u201cThey weren\u2019t looking to get into the healthcare business,\u201d she continued, but \u201cthey were looking for alternatives to wages when there were limits on what they could offer, and they started with what was a pretty inexpensive offering \u2014 helping pay for hospital care \u2014 and that has now grown to be the second-largest line item in their budgets after payroll.\u201d<\/p>\n Rovner and Mitchell discussed the fact that while large employers do have market power, the rest of the healthcare system banded together in response.<\/p>\n \u201cThere\u2019s been this arms race of consolidation, meaning that even the largest employers in the world are smaller and don\u2019t have the leverage many times,\u201d Mitchell said.<\/p>\n Asked to identify the systemic changes large employers would like to see, Mitchell pointed to boosting primary care and referring patients to high-quality specialists. She said changes to business policies \u2014 in particular, banning anti-competitive practices and increasing price transparency \u2014 would help, too.<\/p>\n \u201cWe have a very real affordability crisis,\u201d she said.<\/p>\n An abbreviated version of this interview aired July 16 during Episode 455 of What the Health? From KFF Health News<\/em>: \u201cStates Start Their Medicaid Cuts<\/a>.\u201d<\/p>\n<\/div>\n