This document discusses the regulatory environment for third-party payers in the U.S. healthcare system. It outlines the core context involving employers, providers, payors, government, and patients. It then examines the payment and regulatory dynamics between these groups. Specifically, it looks at how state and federal regulations govern employers, insurers, providers, and patients. The document also discusses challenges around medical travel and whether government payors and employer plans will include coverage for care received from foreign providers over which they have no regulatory control.