Angle Health’s recent fundraise is a good example of where the employer health insurance market is heading. Level-funded plans are growing because they offer employers a more attractive middle ground between fully insured and self-funded coverage. Instead of paying a carrier a fixed premium and giving up all of the upside if claims come in below expectations, the employer pays a fixed monthly amount that covers expected claims, administration, and stop-loss insurance. If the group has a good year, the employer can participate in some of the savings. If claims are unusually high, stop-loss limits the downside. For many employers, this can be economically rational. A relatively healthy population can spend several years paying materially less than it would under a fully insured plan. Eventually, though, a large claim or a worsening risk profile gets reflected in the renewal price. At that point the employer can shop again, move to another level-funded plan, or simply return to fully insured coverage. There is something slightly strange about how much innovation in American healthcare looks like this. We continue to invent increasingly sophisticated ways to decide who should bear healthcare risk, how that risk should be pooled, when it should be repriced, and who should capture the difference between expected and actual claims. Fully insured plans shift the risk to the carrier. Self-funded plans shift more of it to the employer. Level funding slices the risk differently and adds stop-loss. Captives aggregate it across employers. ICHRAs move more of the purchasing decision to individuals. These structures can absolutely matter. Some are better suited to particular employers than others, and better risk financing can produce real savings. But almost none of them address the underlying problem: the unit cost of healthcare itself. A $2,000 MRI is still a $2,000 MRI regardless of whether the claim is ultimately borne by UnitedHealthcare, an employer, a stop-loss carrier, or a captive. The healthcare industry spends an extraordinary amount of energy rearranging financial responsibility for expensive care while comparatively little attention is paid to making the care itself dramatically less expensive to deliver. The more important innovation is not figuring out a better way to finance a $2,000 MRI. It is figuring out how to make the MRI cost $200. Until healthcare starts attacking the underlying unit cost of care delivery, much of what we call cost innovation will continue to be risk shifting.