Research brief
The numbers behind “Public Dollars, Private Prices”
Indiana’s public employers are caught in a vise: SEA 1 property-tax relief is pulling revenue out of local budgets through 2031 while employer health costs compound at the fastest rate in fifteen years.
What this brief covers
This written brief walks through three years of carrier renewal data from 2024 to 2026, maps Indiana’s consolidating carrier landscape, quantifies the $744 million hit projected for public schools, sets out the questions facing the 83 municipalities inside the Aim Medical Trust, explains the new SEA 3 fiduciary duties every third-party administrator and pharmacy benefit manager now owes a public plan sponsor, and makes the case for an independent review of current benefits.
Every premium dollar is a taxpayer dollar. The full figures table and every source used in the analysis are published below, so each claim can be checked against the document it came from.
This brief is the documented source layer for the narrative article. It separates the figures, definitions and published links so readers can verify the argument without working backward through the prose.
Every figure cited
The numbers, and where each one comes from
| Figure | What it is | Source |
|---|---|---|
| 5.4% after changes / 6.6% before; 7.5% small fully-insured initial renewals | 2024 health benefit cost increases | Mercer National Survey (2024 projection release) |
| 6.0% actual; $17,496 per employee | 2025 cost growth | Mercer |
| 6.7% net — highest in 15 years; ~9% gross; over $18,500 per employee | 2026 projection | Mercer |
| 9% median medical trend; double-digit pharmacy trend | 2026 actuarial trend | Segal 2026 Health Plan Cost Trend Survey |
| 8.5% | 2026 medical cost trend | PwC Health Research Institute |
| +9.4% | Prescription spend growth, large employers | Mercer |
| 49% vs 44% | Large employers covering GLP-1s for weight loss, 2025 vs 2024 | Mercer |
| 8th highest in the nation; roughly 3× Medicare | Indiana hospital prices | RAND Hospital Price Transparency Study, 2024 round |
| 260% of Medicare by 2029; direct-to-employer contracts from September 2026; tax exemption at stake | HEA 1004 (2025) price caps on the five largest nonprofit systems | Indiana Capital Chronicle / KFF Health News |
| $744.4M over three years from 2026; $336M in 2028 alone | LSA-projected school revenue loss under SEA 1 | Indiana Coalition for Public Education, citing LSA |
| ~$1.3B | SEA 1 homeowner relief | Indiana Senate Republicans; KSM analyses |
| ~2% per year against 7.6% needed | State tuition support vs district-reported need | Indiana Capital Chronicle, December 2025 |
| 95.3% now / 99.3% in future years | Districts expecting negative impact | ICPE survey |
| 83 members; three-year commitment; banded renewals; “below trend 10 of 12 years”; no published rates, roster or PBM | Aim Medical Trust structure | aimmedicaltrust.org FAQ and About pages, plus 46 North public-records research |
| 31 December 2024 | Elevance (Anthem) closed its acquisition of IU Health Plans | Fierce Healthcare; Forbes |
| 5 of roughly 290 | School corporations joining the State Employee Health Plan for 2026 | Indiana SPD participating-schools page |
| Four duties; binds TPAs and PBMs; effective 1 July 2025; no local-government carve-out | SEA 3 (2025), IC 27-1-25.5 | Enrolled act and codified chapter |
| IC 16-47-1; CVS Caremark; local units may opt in | Indiana Aggregate Prescription Purchasing Program | Indiana Code |
Sources
Published links
- Indiana Coalition for Public Education — 2025 SEA 1 property tax cuts
- Indiana Capital Chronicle — School leaders warn property tax reforms are destabilising budgets (December 2025)
- Mercer — Health insurance cost expected to exceed $18,500 per employee in 2026
- Mercer — Health benefit cost expected to rise 5.4% in 2024
- Segal — 2026 Health Plan Cost Trend Survey
- Indiana Capital Chronicle — Indiana takes on powerful hospitals by capping prices (June 2026)
- WFYI — Indiana hospital prices 8th highest in the nation (RAND, 2024)
- Forbes — Elevance closes Indiana University Health Plans deal (31 December 2024)
- Indiana SPD — School corporations participating in the State Employee Health Plan, 2026
- EZ ERISAPlan — Indiana pharmacy benefit manager reform, SEA 140
- 46 North internal research: Aim Medical Trust structure and roster reconstruction, SEA 3 / IC 27-1-25.5 analysis, and a review of the Bloomington contract register.
How we handled the contested parts
All characterisations of the Aim Medical Trust are drawn from the Trust’s own published FAQ and About pages or from reconstructed public records. The analysis asks questions and says plainly that some members are probably well served — but that not one of them can currently prove it. No overpayment is asserted as fact about any named member.
The remedy and enforcement position under SEA 3 is an open legal question. This brief describes duties on the face of the statute and nothing further. The five-to-fifteen-percent first-review figure is framed as experience-based across engagements and published studies, not as a guarantee.