HRA Council news & Updates

Congratulations to Arizona Gov. Katie Hobbs, State Rep. David Livingston, the Arizona state legislature, and all of our members who supported House Bill 2693, which instructs the Arizona Department of Administration to conduct a feasibility study for individual coverage health reimbursement arrangements. 

The bill was signed into law June 4, 2026, and is anticipated to result in guidance for ICHRA as a solution for state employees. This innovative and practical approach gives a strong signal to Arizona businesses as well as municipalities and organizations nationwide, that ICHRA can be a game-changing benefit for diverse local, regional, and national employee groups. 

Leadership from HRA Council member Brooke Tiner, with Oscar Health, is noted in the story. 

https://www.beckerspayer.com/payer/ichra/could-arizona-swap-traditional-state-employee-health-plans-for-ichras/?origin=PayerE&utm_source=PayerE&utm_medium=email&utm_content=newsletter&oly_enc_id=5977F1087134B7Z

The Centers for Medicare & Medicaid Services, Department of Health and Human Services, posted a proposed rule to the Federal Register: CMS-9883-P.  

Long title: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program

We refer to it as the NBPP for 2027 and have submitted comments on Marketplace stability, innovation, and consumer choice in our comment letter, attached here as a PDF.  CMS-9883-P NBPP Comment Letter HRAC.pdf

HRA Council members are encouraged to submit their own responses, including using ours as appropriate. 

In April 2025, the HRA Council submitted an official response to the Centers for Medicare & Medicaid Services (CMS) regarding the proposed rule titled “2025 Marketplace Integrity and Affordability Proposed Rule” (CMS-9884-P). This proposed rule would introduce several regulatory changes to the operation of the individual market, including elements with potential implications for employers and employees using ICHRAs and QSEHRAs to access health coverage.

The Council’s letter, submitted via Regulations.gov, aims to ensure that the growing ICHRA ecosystem—which now includes large and small employers, brokers, TPAs, and digital health insurance platforms—can continue to thrive under policies that safeguard both integrity and access.

This official comment letter was crafted with input from HRA Council leadership and members, and reflects deep industry experience across all 50 states. It underscores the importance of preserving ICHRA and QSEHRA accessibility, efficiency, and affordability amid regulatory changes.

Here are some key takeaways from our response:

• ICHRA continues to work successfully as a modern alternative to group coverage with strong adoption across employer sizes, and more than 600% growth since its inception.
• Proposed regulatory changes could create unintended consequences such as administrative burden, employee confusion, and barriers to effectuation—particularly regarding shortened Open Enrollment Periods, premium payment windows, and new verification rules for SEP eligibility.
• The Council recommends deferring some implementation timelines (e.g., OEP changes) to 2027, to allow for proper operational updates and employee onboarding.
• The Council urges CMS to consider exemptions or tailored compliance measures for ICHRA/QSEHRA enrollees, given their inherently lower fraud risk and employer-directed nature.
• Stability in individual market tax credits is essential to support robust plan options for employees using ICHRA, especially as employers shift from group to defined contribution models.
• Employers must be protected from liability linked to employee past-due premiums, which could otherwise threaten their ability to offer health benefits through ICHRAs.
• We appreciate CMS's commitment to integrity and look forward to continued dialogue to ensure these important innovations in employer-sponsored insurance remain a viable, growing option for America's workforce.

Click here to read the full letter.

ICHRA was prioritized by the US House Ways and Means Committee, the House committee of jurisdiction for health reimbursement arrangements, at the end of 2024. In December, the HRA Council and other stakeholders received a public Request for Information (RFI) on ICHRA from the office of Rep. Kevin Hern (R-OK), Ways and Means Committee Member and sponsor of the 2023 CHOICE Arrangement Act, ultimately sent back to Committee, which sought to establish statutory authority over ICHRA and other alternative health insurance options for employers. The Council responded to the RFI and is now making the full text of our response available to the public.

This official HRA Council response was developed through close collaboration among our leadership and Members. We believe it represents the best interests of the widest set of health insurance stakeholders, including those employers, health insurance professionals, and US workers who remain unaware of ICHRA's growth, advantages, or even existence.

Here are some key takeaways from our response:

• ICHRA is in great working order as a proven, increasingly popular solution to known challenges in the Employer-Sponsored Health Insurance markets;
• A small set of specific process and regulatory fixes would further reduce the administrative, cost, and change management burdens or disparities in providing ICHRA as a health benefit, while improving the Employer and Employee experience;
• As a Council, we support further consideration of provisions to allow for Employers to offer both traditional group coverage and ICHRA to their entire workforce, further expanding flexibility and choice for both Employers and Employees, already hallmarks of ICHRA as a health benefit option;
• Much more awareness and education should be propagated by the Tri-Agencies overseeing ICHRA, on par with the resources made available to Employers and Employees for understanding other Employer-sponsored benefits.

Click here or the link in the "Comment Letters" section of hracouncil.org/action to see our full response.

For questions, please email robin@hracouncil.org.

Supporting ICHRA Education in Colorado

The HRA Council was honored to be invited by Connect for Health Colorado (C4HC), the Colorado state-based exchange, to provide ICHRA education and updates during C4HC’s pre-open enrollment conference for brokers: CoverCO 2024.

CoverCO organizers asked us to be creative and engaging, so we worked with members to create a “quiz show” feature for the first half of our morning panel on ICHRA 101+.

More than 100 participants, mostly brokers, joined our ICHRA 101+ panel with its fast-paced quiz show format. During the second half of the morning panel, we segued to a live Q&A session. 

The second panel featured an insightful conversation about how defined contribution health coverage is bringing changes to the individual and group markets. “What’s next for ICHRA and Beyond!” also had a great turn-out of broker attendees plus a lively Q&A session that addressed questions ranging from which industries are particularly well-suited for ICHRA, to how to help a company with remote workers in multiple states. 

Thanks to our members and staff for providing top-notch educational resources, and much gratitude to C4HC for inviting us. Learn more about the panels and panelists, below.

Panel 1:  ICHRA 101+

Did you know Colorado is a Top Ten state for ICHRA? Learn with our experts in a fast-paced, dynamic session about ICHRA, the innovative employer-sponsored coverage option that empowers employees to select ACA-compliant plans on- and off-exchange. The HRA Council is an expert ecosystem of carriers, administrators, brokers, health wallets, legal and compliance specialists, and enrollment technology platforms. Moderator: Robin Paoli, Executive Director, The HRA Council

• Libby Hart, Capital Blue
• Tom Crennan, Colorado Health
  
• Jared Dodds, TakeCommand Health
  
• Henry von Hagke, Zizzl

Panel 2:  What’s next for ICHRA and Beyond! 

ICHRA and QSEHRA have been game changers for employers wanting to provide a spectrum of health and wellness benefits to their employees. Learn what changes are coming to plans, products, and benefits, from national experts. Moderator: Robin Paoli, Executive Director, The HRA Council

• Eric Allen, FlyteHCM
  
• Libby Hart, Capital Blue
  
• Michelle Mead, Leeway
  
• Andrew Reeves, gravie

C4HC recorded our sessions and posted the videos and slide decks as educational resources for all CoverCO 2024 participants.

"California Healthline" ran the recent KFF News + NPR Health Shots story about ICHRA. Great to see multiple outlines sharing this combination case study + ICHRA insights. 

https://californiahealthline.org/news/article/ichra-benefit-trend-employers-health-plan-allowance-individual-insurance/

As with the NPR "Shots" and KFF News original stories, this article is free to read and share, and mentions several HRA Council members and leaders.

KFF News in partnership with National Public Radio (NPR) published a well-reported ICHRA case story featuring quotes and news from several HRA Council members and leaders. 

https://kffhealthnews.org/news/article/ichra-benefit-trend-employers-health-plan-allowance-individual-insurance/

This article was trending as the top news story on KFF News and is free to read and share. 

Great to see NPR (National Public Radio), in collaboration with KFF News, publish this well-reported story for consumer and business audiences, including an ICHRA case study. Multiple HRA Council members and leaders are mentioned, some are quoted. 

This link is to the full story, with a sample excerpt immediately below: https://www.npr.org/sections/shots-health-news/2024/09/24/nx-s1-5123888/individual-coverage-health-reimbursement-arrangement 

Excerpt: Growing interest in an alternative to group plans

The plans are currently offered to only a tiny slice of workers: an estimated 500,000 of the roughly 165 million people with employer-sponsored coverage, according to the HRA Council.

But interest is growing. The number of employers offering ICHRAs and an earlier type of plan, called qualified small-employer HRAs, increased 29% from 2023 to 2024, according to the council. And, although small employers have made up the bulk of adopters to date, larger employers with at least 50 workers are the fastest-growing cohort.

Individual market insurers like Oscar Health and Centene see opportunities to expand their footprint through the plans. Some venture capitalists are touting them as well.

“The [traditional group] health insurance cornerstone from 60 years ago has outlived its usefulness,” said Matt Miller, whose Headwater Ventures has invested in the ICHRA administrator Venteur. “The goal is to ensure people have coverage, detaching it from the employment construct and making it portable.”

Kelly Hooper, who covers health care for Politico, contacted the HRA Council about our educational outreach to states. Here's the link to the story:  https://subscriber.politicopro.com/article/2024/09/states-embrace-trump-era-health-insurance-policy-00177827 

Following are excerpts: 

The states’ interest coincides with growing investments in these types of plans from health insurance companies, which see a way to attract new customers to their individual market plans. These are especially important to health insurers as the small group market dwindles in many states and enhanced Obamacare subsidies allow more people to afford individual coverage.

“Every state we talk to, they're interested in this,” said Robin Paoli, executive director of the HRA Council, a coalition of insurers and employers that supports ICHRAs. “It can look different and be described differently, and the public approach might differ between different states, but that underlying interest is, ‘It's good for residents, it's good for the state.’”

ICHRAs provide workers with a tax-free credit to purchase Obamacare plans on the individual market. They’re an alternative for businesses that find it too expensive to purchase traditional group health plans.

“Even in states where there is a more steady, small group market, I don't think anyone opposes more options or alternatives for employers and employees,” said Cathy Grason, head of government affairs at Oscar Health. “It's not a mandate, it's just another alternative.”

The HRA Council has met with Republicans and Democrats on the Hill this year to push for a bill that would codify ICHRA without any add-ons, said Kyle Estep, the senior vice president of strategy and partnerships at Take Command, an ICHRA administrator, who attended the meetings.

“Codification is really the most important step in just providing greater certainty around this as a longer-term bipartisan opportunity for employers to take a different approach to how they do health insurance and give their employees more choice,” he said.

Harvard professor and physician Benjamin D. Sommers, MD, PhD, is a health policy researcher who wrote about ICHRAs (including the HRA Council Data Report) in the JAMA Health Forum this summer: 

https://jamanetwork.com/journals/jama-health-forum/fullarticle/2821807

Dr. Sommers is an independent researcher and his article is examines ICHRA from a variety of viewpoints. We've excerpted two sections, below, that are of particular interest to HRA Council Members.

Here's a brief excerpt: 

"The main potential advantage of the HRA model is that it may offer employers and employees more flexibility. Employers can set a fixed dollar amount instead of having to shop for and purchase insurance. This may induce some small employers to participate who might otherwise not offer health benefits, or who would feel the need to cut benefits in times of rapid premium growth. Health reimbursement arrangements may also enable firms with remote workers across state lines to offer meaningful health benefits because employees can use HRAs to obtain coverage wherever they live. In addition, an HRA gives employees many more plan options than they would typically get, especially from small employers."

"Depending on the evidence that emerges, 2 potential policy improvements could include (1) allowing workers who receive HRA contributions from employers to remain eligible for Marketplace subsidies, offset by the amount of the HRA; and (2) revising the tax code to allow workers who use HRAs to buy Marketplace insurance to deduct their share of the premiums from their taxable income (currently this is only permitted when using HRAs for non-Marketplace coverage). These changes might represent a best of both worlds approach, combining flexibility and affordability."