It is as the author suggests. Protecting formal “insurance plans” where the employer has a plan run by an insurance company, versus self-insured plans, where the employer is self-administering their own plan. A self-insured plan, dominated or not by health savings accounts, might use, from outside services, a “claims” processing/administrator and possibly, jointly with that or separately, a manged-care coordinator and/or a prescription drug processor. With a self-insured plan those are services the self-insured plan selects, or deems to do internally, and not the “insurance”, which is their own benefit plan, with their own rules, premiums, and other financial self-adminstered asepcts, including, importantly buying stop-loss insurance.
They hate competion.