Aequum CEO's SIIA Board Appointment Signals New Push for Price Transparency

CLEVELAND, OH – March 30, 2026 – In a move that underscores the growing urgency around healthcare cost containment, Christine Cooper, CEO and co-founder of aequum LLC, has been appointed to the Board of Directors for the Self-Insurance Institute of America, Inc. (SIIA). The 2026 appointment places a prominent advocate for price transparency and patient protection at the leadership table of one of the nation's most influential bodies for employer-sponsored health plans.

The appointment comes at a critical juncture for the self-insurance industry. Employers who self-fund their health plans are navigating an increasingly treacherous landscape marked by soaring costs, a labyrinth of federal regulations, and heightened fiduciary responsibilities. Cooper’s elevation from her role as co-chair of SIIA’s Price Transparency Committee to a full board position signals a strategic focus on tackling these very issues.

“I am honored to serve on the SIIA Board of Directors at a time when employers are facing increasing financial and regulatory pressure in managing their health plans,” said Cooper in a statement. “Self-insured plan sponsors are navigating complex compliance obligations, rising healthcare costs and heightened fiduciary scrutiny. SIIA plays a critical role in providing leadership and industry collaboration and I look forward to contributing to efforts that strengthen transparency, accountability and sustainability in employer-sponsored healthcare.”

The New Battleground: Cost and Complexity in Self-Insurance

Self-insured health plans, which cover a majority of American workers with employer-provided insurance, operate by paying for employee health claims directly from company funds rather than paying premiums to an insurance carrier. While this model offers flexibility and potential cost savings, it also exposes employers to significant financial risk and a daunting administrative burden.

Recent years have seen these burdens intensify. A Willis Towers Watson survey projected that healthcare plan costs would jump by 6.4% in 2024, placing immense pressure on company budgets. This financial strain is compounded by a complex web of federal rules. The Transparency in Coverage Final Rule and new, stricter Hospital Price Transparency (HPT) requirements that took effect in 2026 mandate unprecedented levels of data disclosure. Simultaneously, the No Surprises Act (NSA) of 2022, while intended to protect patients, has created its own set of administrative challenges for plans.

The NSA has been a double-edged sword. Research shows it has been particularly effective for self-insured plans, which saw average out-of-network payments for emergency services fall by 41% and the prevalence of such bills drop by 15% between 2021 and 2022. However, the independent dispute resolution (IDR) process for settling payment disputes has been overwhelmed, receiving over 209,000 unique disputes in 2023 alone—far exceeding the government's initial estimate of 17,000 per year. This deluge highlights the persistent friction between providers and payers that self-insured plans must manage.

A Champion for Containment Joins the Board

It is within this high-stakes environment that Christine Cooper has built a reputation as a formidable force for cost containment. A former patent lawyer with deep IT expertise, Cooper co-founded aequum in 2020 to directly confront one of the biggest pain points for plan members: balance billing. The company operates as a tech-driven defense firm, using a proprietary data platform and legal advocacy, through its sister organization Koehler Fitzgerald LLC, to challenge unreasonable and egregious medical charges on behalf of patients.

Aequum’s model is distinct in its direct representation of the patient, a strategy it claims has resulted in a 99.1% reduction off disputed charges for the self-funded plans it serves. This focus on patient protection and legal defense has positioned the company as a key partner for the more than 425 self-insured health plans it supports nationwide.

Cooper's appointment to the SIIA board is a recognition of this expertise. Her hands-on experience fighting on the front lines of medical billing disputes and her active leadership on SIIA's Price Transparency Committee give her a unique, ground-level perspective on the practical challenges of implementing federal reforms. Her presence on the board is expected to amplify the voice of plan sponsors and service partners who are seeking not just to comply with regulations, but to leverage them to drive down costs and protect their employees.

Navigating the Regulatory and Fiduciary Maze

Beyond the high-profile No Surprises Act, self-insured employers face a growing list of compliance and fiduciary duties that demand constant vigilance. Plan fiduciaries are under increasing scrutiny to ensure all vendor contracts, including those with Pharmacy Benefit Managers (PBMs), are reasonable and that the plan is administered solely for the benefit of its participants.

New federal rules set to take effect for plan years after July 1, 2026, will require fiduciaries to obtain and evaluate detailed PBM compensation disclosures before signing contracts. This push for transparency in the notoriously opaque world of drug pricing is another front in the broader war on healthcare costs. Likewise, ensuring strict compliance with HIPAA privacy and security rules, especially when coordinating with third-party administrators (TPAs), remains a paramount and complex responsibility.

Cooper’s work at aequum directly addresses the consequences when these complex systems fail the patient. By challenging bills that arise from network inaccuracies, opaque pricing, and aggressive billing practices, her firm provides a crucial backstop for employers. Her elevation to the SIIA board suggests a growing consensus that such defense mechanisms are no longer a niche service but a core component of responsible plan management. Her expertise will be invaluable as SIIA helps guide its members through the evolving legal landscape and shapes advocacy efforts to address shortcomings in current legislation.

The Path Forward for Employer-Sponsored Healthcare

The SIIA board, composed of senior leaders from across the self-insurance ecosystem—including stop-loss carriers, TPAs, and brokers—is instrumental in setting the industry's agenda. The inclusion of a leader like Cooper, whose company’s mission is rooted in challenging the status quo of medical billing, signifies a powerful commitment to empowering employers and their plan members.

As she contributes to SIIA's strategic priorities, Cooper's influence will likely be felt in the association's advocacy on Capitol Hill and its educational initiatives for plan sponsors. Her focus on leveraging transparency data, defending against unreasonable charges, and ensuring fiduciary accountability aligns with the most pressing needs of self-insured employers today. The appointment signals a clear direction for the industry: one that moves beyond mere compliance toward a more proactive and aggressive stance in managing healthcare costs and protecting the financial wellbeing of millions of American workers.