Latest news with #ICHRAs
Politico
5 days ago
- Health
- Politico
The GOP's Obamacare problem
Presented by With help from Carmen Paun and Erin Schumaker Driving the Day KILLING THE BUZZ? Republicans might unwittingly undermine the growing popularity of a first-term Trump policy that encourages Obamacare sign-ups, Kelly reports. In 2019, the first Trump administration finalized a rule permitting employers to offer their workers a tax credit to purchase health insurance on the Affordable Care Act exchange in lieu of offering them a group plan. Few employers initially took up the offer, but the high costs and administrative burden that come with providing traditional group plans have lately prompted more companies to adopt the arrangements, health insurance brokers told POLITICO. Republicans favor the policy, called Individual Coverage Health Reimbursement Arrangements, because it promotes individual choice in health coverage. Democrats don't mind it either because it bolsters Obamacare. And employers are growing more interested: ICHRA adoption has surged more than 1,000 percent since 2020, according to an HRA Council report. But major obstacles threaten its course. Why it matters: Changes to the ACA in Republicans' recently enacted megabill, the expiration of enhanced federal Obamacare subsidies at year's end and a new Trump administration marketplace rule could lead to fewer young and healthy people in the ACA market and higher premiums. The blend of federal policies could make offering ICHRAs much less attractive for employers, policy experts said. 'For that to be a viable option for the employer to do, the individual market has to be a sustainable, viable market to send your workers to,' said Cori Uccello, a senior health fellow at the American Academy of Actuaries. Key context: Republicans argue the new policies, some of which crack down on ACA enrollment verification, are necessary to address widespread broker and enrollment fraud, even if the changes mean a less stable marketplace with higher premiums. 'I don't think we want a structure where there's millions of people who are receiving subsidies that they don't qualify for,' said Brian Blase, president of the right-leaning Paragon Health Institute and a former Trump adviser who was one of the architects of the ICHRA policy. An earlier version of the GOP megabill that passed the House would have codified the ICHRA policy into statute and offered tax incentives to employers choosing to adopt the arrangements. The provisions were ultimately stripped from the final version of the bill, but Blase and other ICHRA proponents still hope Congress will pass the provisions in a future spending bill or a bipartisan standalone health care package. And state lawmakers nationwide are promoting the policy, too, introducing and passing legislation to incentivize uptake. Even so: Policy experts said the efforts are ill-fated, given the spate of Republican-led policy changes expected to weaken the Obamacare marketplace and increase premium costs over the next few years. 'ICHRAs are only going to be as attractive as the individual market is attractive,' said Ellen Montz, a managing director with advisory firm Manatt Health and a former Centers for Medicare and Medicaid Services official during the Biden administration. WELCOME TO THURSDAY PULSE. President Donald Trump's plans for artificial intelligence include a push to grow AI adoption in health care. Send your tips, scoops and feedback to khooper@ and sgardner@ and follow along @kelhoops and @sophie_gardnerj. MORNING MONEY: CAPITAL RISK — POLITICO's flagship financial newsletter has a new Friday edition built for the economic era we're living in: one shaped by political volatility, disruption and a wave of policy decisions with sector-wide consequences. Each week, Morning Money: Capital Risk brings sharp reporting and analysis on how political risk is moving markets and how investors are adapting. Want to know how health care regulation, tariffs or court rulings could ripple through the economy? Start here. In Congress CHRISTINE GETS A VOTE — A key Senate committee will vote today on whether to advance President Donald Trump's nomination of Dr. Brian Christine to serve as one of the highest-ranking HHS officials. Christine, a men's sexual health doctor and a longtime GOP donor, faced the Senate Health, Education, Labor and Pensions Committee last week for a confirmation hearing to be assistant HHS secretary for health. During the hearing, Christine positioned himself as a 'main street doctor' with a direct link to the patient experience, noting his alignment with the Make America Healthy Again movement to combat chronic disease and his opposition to gender-affirming care. He received little pushback from Republicans on the HELP Committee and endured an expected probe from Democrats — who tried to make him answer for HHS Secretary Robert F. Kennedy Jr.'s fringe views or Trump's Medicaid cuts. Why it matters: If confirmed by the full Senate, Christine would be charged with overseeing the uniformed public health service and helping carry out Kennedy's public health agenda. The assistant secretary for health advises the HHS secretary and recommends policy related to public health matters like disease prevention, vaccine programs and health disparities. What's next: If the committee approves Christine's nomination today, it will advance to the full Senate floor for a vote. PUBLIC OPINION ON THE BBB — Nearly half of Americans believe the GOP's recently enacted 'big, beautiful bill' will hurt them, according to a new poll from health policy think tank KFF. About a quarter of adults — including more than half of Republicans — believe the law will help them, according to the poll. People identifying as supporters of President Donald Trump's Make America Great Again movement were over five times more likely to say the law will help their families than hurt them. The remaining quarter said they don't expect to be affected by the law. Background: The One Big Beautiful Bill Act includes key components of Trump's domestic agenda, like tax cuts and border security, and is estimated to reduce health care spending by more than $1 trillion, with most of those cuts coming from Medicaid, the health insurance program serving more than 70 million low-income Americans. The Congressional Budget Office has estimated that about 10 million people could lose health insurance as a result of the changes in the megabill, which also includes changes to the Affordable Care Act. Two-thirds of Medicaid enrollees said the law will hurt their families, according to the poll. The survey was conducted from July 8 to 14, online and by telephone, among a nationally representative sample of 1,283 U.S. adults. In the States 'MAHA WINS' IN IDAHO — Health Secretary Robert F. Kennedy Jr. held an event with Idaho's Republican Gov. Brad Little on Wednesday to celebrate new initiatives in the state his office dubbed 'MAHA wins,' Carmen reports. The measures include the Agriculture Department approving the state's waiver to allow Idaho to exclude soda and candy from items that can be purchased with Supplemental Nutrition Assistance Program benefits. They also touted a bill the governor signed into law in April barring businesses, schools and other entities from restricting entry, services or employment based on requirements to be vaccinated or undergo certain medical tests or treatments. 'I'm very happy to be here in Idaho, which is the home of medical freedom, home of good health,' Kennedy said. Why it matters: The Idaho visit is part of a tour Kennedy has embarked on across Republican-led states to highlight state legislation in line with his Make America Healthy Again movement. Today, he'll visit the Nez Perce Tribe in Lenore, Idaho, where he'll discuss with tribe leaders 'the importance of preserving traditional foods and the role they play in combating chronic disease,' according to HHS. At the Agencies MICROSOFT HACK HITS NIH — The National Institutes of Health is among the victims of a breach of Microsoft's SharePoint collaboration software, HHS confirmed to POLITICO on Wednesday, Erin reports. 'The Department and its security teams are actively engaged in monitoring, identifying and mitigating all risks to our IT systems posed by the Microsoft SharePoint vulnerability,' HHS spokesperson Andrew Nixon said in a statement. 'At present, we have no indication that any information was breached as a result of this vulnerability,' Nixon said. 'HHS takes the protection of our information, systems and networks seriously, and are handling this issue with the utmost diligence and care.' Big picture: Microsoft first reported the widespread cyberattack, which has impacted dozens of organizations globally, on Saturday. On Tuesday, the company confirmed in a blog post that three Chinese hacking groups, known as Violet Typhoon, Linen Typhoon and Storm-2603, were among those behind the attack. Multiple federal agencies are believed to have been breached, while more have yet to be fully investigated. The SharePoint breach is considered severe because it lets hackers remotely access Microsoft users' self-hosted versions of the service. Once inside, hackers can go deeper into the users' networks to access sensitive material. Versions of the software hosted on the cloud are not vulnerable to the attack. The Washington Post first reported that NIH was involved in the breach. OZ ON THE HILL — Centers for Medicare and Medicaid Services Administrator Mehmet Oz defended the One Big Beautiful Bill Act's steep Medicaid cuts during a closed-door meeting with House Ways and Means Democrats and Republicans today, framing them as efforts to curb 'waste, fraud and abuse,' POLITICO's Robert King reports. The $1 trillion in health spending reductions projected by the CBO — mostly cuts from Medicaid — sparked skepticism from Democrats, who warned of coverage losses, especially under new work requirements for some able-bodied adults. Oz argued that those losing Medicaid could shift to other insurance, while critics said most affected already work and predicted enrollment drops tied to red tape. CMS did not return a request for comment on the roundtable. Names in the News Tony Dieste has been named chief marketing officer at health care technology company Dieste is the founder and chair of Dieste, Inc. WHAT WE'RE READING POLITICO's Kimberly Leonard and Arek Sarkissian report on the abortion rights fight at the center of the Florida Democratic governor primary. POLITICO's Katherine Tully-McManus reports on the House Appropriations Committee approving a bill that cuts funding for the State Department and foreign-aid programs by 22 percent. The New York Times' Stephanie Nolen reports on the U.S. quietly drafting plans to end a federal program that saved millions from AIDS.
Yahoo
18-06-2025
- Business
- Yahoo
More employers adopting ICHRAs, giving workers money to buy their own health insurance
A small, growing number of employers are putting health insurance decisions entirely in the hands of their workers. Instead of offering traditional insurance, they're giving workers money to buy their own coverage in what's known as Individual Coverage Health Reimbursement Arrangements, or ICHRAs. Advocates say this approach provides small companies that couldn't afford insurance a chance to offer something. It also caps a growing expense for employers and fits conservative political goals of giving people more purchasing power over their coverage. But ICHRAs place the risk for finding coverage on the employee, and they force them to do something many dislike: Shop for insurance. 'It's maybe not perfect, but it's solving a problem for a lot of people,' said Cynthia Cox, of the nonprofit KFF, which studies health care issues. Here's a closer look at how this approach to health insurance is evolving. What's an ICHRA? Normally, U.S. employers offering health coverage will have one or two insurance options for workers through what's known as a group plan. The employers then pick up most of the premium, or cost of coverage. ICHRAs are different: Employers contribute to health insurance coverage, but the workers then pick their own insurance plans. The employers that use ICHRAs hire outside firms to help people make their coverage decisions. ICHRAs were created during President Donald Trump's first administration. Enrollment started slowly but has swelled in recent years. What's the big deal about ICHRAs? They give business owners a predictable cost, and they save companies from having to make coverage decisions for employees. 'You have so many things you need to focus on as a business owner to just actually grow the business,' said Jeff Yuan, co-founder of the New York-based insurance startup Taro Health. Small businesses, in particular, can be vulnerable to annual insurance cost spikes, especially if some employees have expensive medical conditions. But the ICHRA approach keeps the employer cost more predictable. Yuan's company bases its contributions on the employee's age and how many people are covered under the plan. That means it may contribute anywhere from $400 to more than $2,000 monthly to an employee's coverage. How is this approach different? ICHRAs let people pick from among dozens of options in an individual insurance market instead of just taking whatever their company offers. That may give people a chance to find coverage more tailored to their needs. Some insurers, for instance, offer plans designed for people with diabetes. And workers can keep the coverage if they leave — potentially for longer periods than they would be able to with traditional employer health insurance plans. They likely will have to pay the full premium, but keeping the coverage also means they won't have to find a new plan that covers their doctors. Mark Bertolini, CEO of the insurer Oscar Health, noted that most people change jobs several times. 'Insurance works best when it moves with the consumer,' said the executive, whose company is growing enrollment through ICHRAs in several states. What are the drawbacks for employees? Health insurance plans on the individual market tend to have narrower coverage networks than employer-sponsored coverage. It may be challenging for patients who see several doctors to find one plan that covers them all. People shopping for their own insurance can find coverage choices and terms like deductibles or coinsurance overwhelming. That makes it important for employers to provide help with plan selection. The broker or technology platform setting up a company's ICHRA generally does this by asking about their medical needs or if they have any surgeries planned in the coming year. How many people get coverage this way? There are no good numbers nationally that show how many people have coverage through an ICHRA or a separate program for companies with 50 workers or less. However, the HRA Council, a trade association that promotes the arrangements, sees big growth. The council works with companies that help employers offer the ICHRAs. It studies growth in a sample of those businesses. It says about 450,000 people were offered coverage through these arrangements this year. That's up 50% from 2024. Council Executive Director Robin Paoli says the total market may be twice as large. Still, these arrangements make up a sliver of employer-sponsored health coverage in the United States. About 154 million people were enrolled in coverage through work last year, according to KFF. Will growth continue? Several things could cause more employers to offer ICHRAs. As health care costs continue to climb, more companies may look to limit their exposure to the hit. Some tax breaks and incentives that encourage the arrangements could wind up in a final version of the Republican tax bill currently under consideration in the Senate. More people also will be eligible for the arrangements if extra government subsidies that help buy coverage on the Affordable Care Act's individual marketplaces expire this year. You can't participate in an ICHRA if you are already getting a subsidy from the government, noted Brian Blase, a White House health policy adviser in the first Trump administration. 'The enhanced subsidies, they crowd out private financing,' he said. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content. Tom Murphy, The Associated Press Sign in to access your portfolio
18-06-2025
- Business
More employers are sending workers shopping for their own health coverage
A small, growing number of employers are putting health insurance decisions entirely in the hands of their workers. Instead of offering traditional insurance, they're giving workers money to buy their own coverage in what's known as Individual Coverage Health Reimbursement Arrangements, or ICHRAs. Advocates say this approach provides small companies that couldn't afford insurance a chance to offer something. It also caps a growing expense for employers and fits conservative political goals of giving people more purchasing power over their coverage. But ICHRAs place the risk for finding coverage on the employee, and they force them to do something many dislike: Shop for insurance. 'It's maybe not perfect, but it's solving a problem for a lot of people,' said Cynthia Cox, of the nonprofit KFF, which studies health care issues. Here's a closer look at how this approach to health insurance is evolving. Normally, U.S. employers offering health coverage will have one or two insurance options for workers through what's known as a group plan. The employers then pick up most of the premium, or cost of coverage. ICHRAs are different: Employers contribute to health insurance coverage, but the workers then pick their own insurance plans. The employers that use ICHRAs hire outside firms to help people make their coverage decisions. ICHRAs were created during President Donald Trump's first administration. Enrollment started slowly but has swelled in recent years. They give business owners a predictable cost, and they save companies from having to make coverage decisions for employees. 'You have so many things you need to focus on as a business owner to just actually grow the business,' said Jeff Yuan, co-founder of the New York-based insurance startup Taro Health. Small businesses, in particular, can be vulnerable to annual insurance cost spikes, especially if some employees have expensive medical conditions. But the ICHRA approach keeps the employer cost more predictable. Yuan's company bases its contributions on the employee's age and how many people are covered under the plan. That means it may contribute anywhere from $400 to more than $2,000 monthly to an employee's coverage. ICHRAs let people pick from among dozens of options in an individual insurance market instead of just taking whatever their company offers. That may give people a chance to find coverage more tailored to their needs. Some insurers, for instance, offer plans designed for people with diabetes. And workers can keep the coverage if they leave — potentially for longer periods than they would be able to with traditional employer health insurance plans. They likely will have to pay the full premium, but keeping the coverage also means they won't have to find a new plan that covers their doctors. Mark Bertolini, CEO of the insurer Oscar Health, noted that most people change jobs several times. 'Insurance works best when it moves with the consumer,' said the executive, whose company is growing enrollment through ICHRAs in several states. Health insurance plans on the individual market tend to have narrower coverage networks than employer-sponsored coverage. It may be challenging for patients who see several doctors to find one plan that covers them all. People shopping for their own insurance can find coverage choices and terms like deductibles or coinsurance overwhelming. That makes it important for employers to provide help with plan selection. The broker or technology platform setting up a company's ICHRA generally does this by asking about their medical needs or if they have any surgeries planned in the coming year. There are no good numbers nationally that show how many people have coverage through an ICHRA or a separate program for companies with 50 workers or less. However, the HRA Council, a trade association that promotes the arrangements, sees big growth. The council works with companies that help employers offer the ICHRAs. It studies growth in a sample of those businesses. It says about 450,000 people were offered coverage through these arrangements this year. That's up 50% from 2024. Council Executive Director Robin Paoli says the total market may be twice as large. Still, these arrangements make up a sliver of employer-sponsored health coverage in the United States. About 154 million people were enrolled in coverage through work last year, according to KFF. Several things could cause more employers to offer ICHRAs. As health care costs continue to climb, more companies may look to limit their exposure to the hit. Some tax breaks and incentives that encourage the arrangements could wind up in a final version of the Republican tax bill currently under consideration in the Senate. More people also will be eligible for the arrangements if extra government subsidies that help buy coverage on the Affordable Care Act's individual marketplaces expire this year. You can't participate in an ICHRA if you are already getting a subsidy from the government, noted Brian Blase, a White House health policy adviser in the first Trump administration. 'The enhanced subsidies, they crowd out private financing,' he said. ___
The Hill
18-06-2025
- Business
- The Hill
More employers are sending workers shopping for their own health coverage
A small, growing number of employers are putting health insurance decisions entirely in the hands of their workers. Instead of offering traditional insurance, they're giving workers money to buy their own coverage in what's known as Individual Coverage Health Reimbursement Arrangements, or ICHRAs. Advocates say this approach provides small companies that couldn't afford insurance a chance to offer something. It also caps a growing expense for employers and fits conservative political goals of giving people more purchasing power over their coverage. But ICHRAs place the risk for finding coverage on the employee, and they force them to do something many dislike: Shop for insurance. 'It's maybe not perfect, but it's solving a problem for a lot of people,' said Cynthia Cox, of the nonprofit KFF, which studies health care issues. Here's a closer look at how this approach to health insurance is evolving. Normally, U.S. employers offering health coverage will have one or two insurance options for workers through what's known as a group plan. The employers then pick up most of the premium, or cost of coverage. ICHRAs are different: Employers contribute to health insurance coverage, but the workers then pick their own insurance plans. The employers that use ICHRAs hire outside firms to help people make their coverage decisions. ICHRAs were created during President Donald Trump's first administration. Enrollment started slowly but has swelled in recent years. They give business owners a predictable cost, and they save companies from having to make coverage decisions for employees. 'You have so many things you need to focus on as a business owner to just actually grow the business,' said Jeff Yuan, co-founder of the New York-based insurance startup Taro Health. Small businesses, in particular, can be vulnerable to annual insurance cost spikes, especially if some employees have expensive medical conditions. But the ICHRA approach keeps the employer cost more predictable. Yuan's company bases its contributions on the employee's age and how many people are covered under the plan. That means it may contribute anywhere from $400 to more than $2,000 monthly to an employee's coverage. ICHRAs let people pick from among dozens of options in an individual insurance market instead of just taking whatever their company offers. That may give people a chance to find coverage more tailored to their needs. Some insurers, for instance, offer plans designed for people with diabetes. And workers can keep the coverage if they leave — potentially for longer periods than they would be able to with traditional employer health insurance plans. They likely will have to pay the full premium, but keeping the coverage also means they won't have to find a new plan that covers their doctors. Mark Bertolini, CEO of the insurer Oscar Health, noted that most people change jobs several times. 'Insurance works best when it moves with the consumer,' said the executive, whose company is growing enrollment through ICHRAs in several states. Health insurance plans on the individual market tend to have narrower coverage networks than employer-sponsored coverage. It may be challenging for patients who see several doctors to find one plan that covers them all. People shopping for their own insurance can find coverage choices and terms like deductibles or coinsurance overwhelming. That makes it important for employers to provide help with plan selection. The broker or technology platform setting up a company's ICHRA generally does this by asking about their medical needs or if they have any surgeries planned in the coming year. There are no good numbers nationally that show how many people have coverage through an ICHRA or a separate program for companies with 50 workers or less. However, the HRA Council, a trade association that promotes the arrangements, sees big growth. The council works with companies that help employers offer the ICHRAs. It studies growth in a sample of those businesses. It says about 450,000 people were offered coverage through these arrangements this year. That's up 50% from 2024. Council Executive Director Robin Paoli says the total market may be twice as large. Still, these arrangements make up a sliver of employer-sponsored health coverage in the United States. About 154 million people were enrolled in coverage through work last year, according to KFF. Several things could cause more employers to offer ICHRAs. As health care costs continue to climb, more companies may look to limit their exposure to the hit. Some tax breaks and incentives that encourage the arrangements could wind up in a final version of the Republican tax bill currently under consideration in the Senate. More people also will be eligible for the arrangements if extra government subsidies that help buy coverage on the Affordable Care Act's individual marketplaces expire this year. You can't participate in an ICHRA if you are already getting a subsidy from the government, noted Brian Blase, a White House health policy adviser in the first Trump administration. 'The enhanced subsidies, they crowd out private financing,' he said. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content.
San Francisco Chronicle
18-06-2025
- Business
- San Francisco Chronicle
More employers are sending workers shopping for their own health coverage
A small, growing number of employers are putting health insurance decisions entirely in the hands of their workers. Instead of offering traditional insurance, they're giving workers money to buy their own coverage in what's known as Individual Coverage Health Reimbursement Arrangements, or ICHRAs. Advocates say this approach provides small companies that couldn't afford insurance a chance to offer something. It also caps a growing expense for employers and fits conservative political goals of giving people more purchasing power over their coverage. But ICHRAs place the risk for finding coverage on the employee, and they force them to do something many dislike: Shop for insurance. 'It's maybe not perfect, but it's solving a problem for a lot of people,' said Cynthia Cox, of the nonprofit KFF, which studies health care issues. Here's a closer look at how this approach to health insurance is evolving. What's an ICHRA? Normally, U.S. employers offering health coverage will have one or two insurance options for workers through what's known as a group plan. The employers then pick up most of the premium, or cost of coverage. ICHRAs are different: Employers contribute to health insurance coverage, but the workers then pick their own insurance plans. The employers that use ICHRAs hire outside firms to help people make their coverage decisions. ICHRAs were created during President Donald Trump's first administration. Enrollment started slowly but has swelled in recent years. What's the big deal about ICHRAs? They give business owners a predictable cost, and they save companies from having to make coverage decisions for employees. 'You have so many things you need to focus on as a business owner to just actually grow the business,' said Jeff Yuan, co-founder of the New York-based insurance startup Taro Health. Small businesses, in particular, can be vulnerable to annual insurance cost spikes, especially if some employees have expensive medical conditions. But the ICHRA approach keeps the employer cost more predictable. Yuan's company bases its contributions on the employee's age and how many people are covered under the plan. That means it may contribute anywhere from $400 to more than $2,000 monthly to an employee's coverage. How is this approach different? ICHRAs let people pick from among dozens of options in an individual insurance market instead of just taking whatever their company offers. That may give people a chance to find coverage more tailored to their needs. Some insurers, for instance, offer plans designed for people with diabetes. And workers can keep the coverage if they leave — potentially for longer periods than they would be able to with traditional employer health insurance plans. They likely will have to pay the full premium, but keeping the coverage also means they won't have to find a new plan that covers their doctors. Mark Bertolini, CEO of the insurer Oscar Health, noted that most people change jobs several times. 'Insurance works best when it moves with the consumer,' said the executive, whose company is growing enrollment through ICHRAs in several states. What are the drawbacks for employees? Health insurance plans on the individual market tend to have narrower coverage networks than employer-sponsored coverage. It may be challenging for patients who see several doctors to find one plan that covers them all. People shopping for their own insurance can find coverage choices and terms like deductibles or coinsurance overwhelming. That makes it important for employers to provide help with plan selection. The broker or technology platform setting up a company's ICHRA generally does this by asking about their medical needs or if they have any surgeries planned in the coming year. How many people get coverage this way? There are no good numbers nationally that show how many people have coverage through an ICHRA or a separate program for companies with 50 workers or less. However, the HRA Council, a trade association that promotes the arrangements, sees big growth. The council works with companies that help employers offer the ICHRAs. It studies growth in a sample of those businesses. It says about 450,000 people were offered coverage through these arrangements this year. That's up 50% from 2024. Council Executive Director Robin Paoli says the total market may be twice as large. Still, these arrangements make up a sliver of employer-sponsored health coverage in the United States. About 154 million people were enrolled in coverage through work last year, according to KFF. Will growth continue? Several things could cause more employers to offer ICHRAs. As health care costs continue to climb, more companies may look to limit their exposure to the hit. Some tax breaks and incentives that encourage the arrangements could wind up in a final version of the Republican tax bill currently under consideration in the Senate. More people also will be eligible for the arrangements if extra government subsidies that help buy coverage on the Affordable Care Act's individual marketplaces expire this year. You can't participate in an ICHRA if you are already getting a subsidy from the government, noted Brian Blase, a White House health policy adviser in the first Trump administration. 'The enhanced subsidies, they crowd out private financing,' he said.
