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Yahoo
2 days ago
- Health
- Yahoo
ICHRA adoption grows as Congress mulls codifying the coverage into law
This story was originally published on Healthcare Dive. To receive daily news and insights, subscribe to our free daily Healthcare Dive newsletter. A nascent form of health coverage that creates an alternative gateway for employers to offer Affordable Care Act coverage to their workers is seeing rising uptake, especially among midsize to large employers. Adoption of individual coverage health reimbursement arrangements, or ICHRA plans, rose 34% from 2024 to 2025 among employers with 50 or more full-time employees, according to a new report from trade association the HRA Council. Still, the vast majority of ICHRA users remain companies with fewer than 20 employees, most of which are providing health coverage for the first time through the arrangements, the HRA Council said. ICHRA allows employees to shop and choose between plans on the ACA exchanges and have some or all of the cost offset by their employer through a stipend. Unlike in traditional group health plans, businesses can set a fixed amount to help their workers cover healthcare costs, defraying some financial risk from offering insurance. ICHRAs were first available as a coverage option in 2020, and have grown rapidly since, according to research. However, the lack of industry-wide data collection makes it difficult to get a clear picture of adoption nationwide — market experts estimate about 500,000 to one million Americans are covered in ICHRA arrangements. About 450,000 U.S. employees and their dependents were offered ICHRA or a qualified small employer HRA for the 2025 plan year, according to the new report. However, that estimate should be taken as a floor for the larger overall market, which could encompass one million people or more, the HRA Council said. Proponents of ICHRAs argue they create an avenue for employers to offer benefits that they may not be able to otherwise afford. The share of small businesses offering health insurance has dropped significantly over the past two decades, from upwards of 47% in 2000 to about 30% in 2023, according to an analysis by health software company TakeCommand. That decline has coincided with an increase in the cost of providing employer-sponsored insurance. As for employees, ICHRAs give them freedom to choose from a variety of plans based on their needs, instead of from a smaller range of choices set up by their employer. People who enroll in ACA plans via ICHRA tend to be younger as well, a population that's usually healthier — so, their enrollment helps stabilize the risk pools and keep marketplace plans affordable, ICHRA advocates say. The coverage arrangements were expanded by President Donald Trump during his first term in rulemaking in 2019, as the president promoted policy alternatives to traditional ACA coverage. However, unlike many of the Trump administration's healthcare priorities, ICHRAs enjoy relatively bipartisan support. Democrats generally approve of ICHRAs because they add new members to the ACA marketplaces, while Republicans support the expanded choices they provide employees. Though ICHRAs are backed by regulation, the plans have never been backed by law. However, that could soon change. Republicans in Congress are currently considering codifying ICHRAs as 'Custom Health Option and Individual Care Expense' or 'CHOICE' plans. Massive reconciliation legislation passed by the House in June would also provide small employers offering ICHRAs with a tax credit. However, the Senate Finance Committee stripped the ICHRA provisions from the upper house's version of the bill released on Monday. To date, Indiana is the only state that's established a tax credit for ICHRA adoption, though a handful of others — including Ohio, Texas and Georgia — are considering the legislation that would create incentives for small employers to offer the arrangements, according to the HRA Council. The legislative uncertainty hasn't stopped private equity, venture capital and some major insurance companies from investing heavily into ICHRAs, betting that the market for the products will continue to grow. Investors have funneled millions of dollars into companies providing ICHRA administration and health benefits technology. Funding rounds this year alone include upwards of $100 million for Remodel Health, $40 million for Thatch and $20 million for Venteur, for example. Meanwhile Centene, the largest marketplace carrier in the U.S., is embarking on a full-court press to introduce more employees to its ICHRA plans. The insurer recently created a division wholly dedicated to promoting ICHRA and launched the arrangements in six states during open enrollment for 2025. 'Large-scale ICHRA adoption will be a journey of several years ... but considering the small group health insurance market covers 62 million Americans and the full commercial group market covers 170 million, we see a healthy addressable market over the long term,' Centene CEO Sarah London said during the payer's investor day in December. 'Aggressively pursuing this line of business is an easy choice,' London added. Similarly, Oscar Health has worked to expand its ICHRA membership, viewing it as a valuable alternative for smaller businesses to provide insurance as medical costs continue to rise, CEO Mark Bertolini said during an Axios event in Washington, D.C. in May. Recommended Reading Centene appoints first head of ICHRA products
CTV News
4 days ago
- Health
- CTV News
Pregnant woman facing $20K bill to have baby in Manitoba after health-care coverage denied
A pregnant woman has been denied health coverage in Manitoba as she's still waiting for her permanent residency to be approved. Danton Unger explains.
CTV News
4 days ago
- Health
- CTV News
Pregnant woman denied health coverage, facing $20K bill to have baby in Manitoba
Nikka Worth has been denied health coverage and is expecting to pay thousands of dollars out of pocket to have her baby in Manitoba. Uploaded June 16, 2025. (Danton Unger/CTV News Winnipeg) A pregnant woman will have to pay thousands of dollars to have her baby in Manitoba after being denied health coverage and losing an appeal. Nikka and Andrew Worth are expecting their first child, a baby girl, at the end of the month. However, the pregnancy is being paid for out of pocket after Manitoba Health denied coverage to Nikka. 'We are at the last stretch. I'm nine months pregnant and no matter what – we will be taken care of,' Nikka told CTV News. 'But it's just that we want to fight for what's fair.' As CTV News first reported, the couple met last year while Nikka was visiting Canada from the Philippines. They fell in love and got married in September. Shortly after, they found out their little family was about to grow. Read more: 'It doesn't feel right': Pregnant woman denied health coverage over provincial 'grey area' The problem is Nikka – a Filipino citizen – is currently in Canada on a visitor record – an extended visitor visa that expires in November. She has been waiting for her permanent residence to be approved. Until it is, Nikka said she's been told she is not eligible for provincial health coverage – despite the fact she's married to a Manitoba resident and the child she's carrying will be a Canadian citizen. 'Canadian health care, I think, is a real point of pride for a lot of Canadians,' said Andrew. 'This has been kind of disillusioning to myself.' Andrew said what makes the situation even more frustrating, is the fact that there are exceptions in Manitoba's rules. According to the province, the spouse of a work permit holder would be eligible for health coverage, but not the spouse of a Canadian citizen. The couple took their case to the Manitoba Health Appeal Board, but it was dismissed earlier this month. 'Unfortunately, the specific wording found within the Act… does not allow for health benefits to be extended to the spouse until they are determined to be a 'resident,'' the board said in a decision obtained by CTV News. CTV News reached out to the Health Minister for comment. A spokesperson from the provincial cabinet communications team responded by email. 'Manitoba provides insurance based on your residency status, which is determined by the federal government,' the email reads, adding if the federal government determines you are a resident, you would be covered by Manitoba. 'Manitoba stipulates that insurance is tied to residency in the Health Services Insurance Act.' All this means Nikka and Andrew will have to cover the cost of the pregnancy. They've already spent about $5,000 on prenatal care and ultrasounds. As for the actual delivery, they've been told a single night in hospital will cost nearly $6,000. If there are any complications, a night in the ICU would cost them more than $16,000. Altogether, in order to bring their baby home, Nikka and Andrew are expecting to pay more than $20,000. They say there is a silver lining, as they've been told the baby will be covered by Manitoba Health. To cover the costs, the couple have taken out a line of credit from the bank and launched a GoFundMe. 'We would just have to pay it off like you pay off a car,' Andrew said. 'We're going to have to take on debt to have a child in Canada, which seems almost ludicrous.'
Associated Press
09-06-2025
- Health
- Associated Press
Georgia's experience raises red flags for Medicaid work requirement moving through Congress
ATLANTA (AP) — Georgia's experiment with a work requirement for Medicaid offers a test of a similar mandate Republicans in Congress want to implement nationally, and advocates say the results so far should serve as a warning. Just days shy of its two-year anniversary, the Georgia Medicaid program is providing health coverage to about 7,500 low-income residents, up from 4,300 in the first year, but far fewer than the estimated 240,000 people who could qualify. The state had predicted at least 25,000 enrollees in the first year and nearly 50,000 in the second year. Applicants and beneficiaries have faced technical glitches and found it nearly impossible at times to reach staff for help, despite more than $50 million in federal and state spending on computer software and administration. The program, dubbed Georgia Pathways, had a backlog of more than 16,000 applications 14 months after its July 2023 launch, according to a renewal application Georgia submitted to the Trump administration in April. 'The data on the Pathways program speaks for itself,' said Laura Colbert, executive director of Georgians for a Healthy Future, an advocacy group that has called for a broader expansion of Medicaid without work requirements. 'There are just so many hurdles at every step of the way that it's just a really difficult program for people to enroll in and then to stay enrolled in too.' Georgia's rules A tax and spending bill backed by President Donald Trump and Republican lawmakers that passed the U.S. House in May would require many able-bodied Medicaid enrollees under 65 to show that they work, volunteer or go to school. The bill is now in the Senate, where Republicans want significant changes. Pathways requires beneficiaries to perform 80 hours a month of work, volunteer activity, schooling or vocational rehabilitation. It's the only Medicaid program in the nation with a work requirement. But Georgia recently stopped checking each month whether beneficiaries were meeting the mandate. Colbert and other advocates view that as evidence that state staff was overburdened with reviewing proof-of-work documents. Fiona Roberts, a spokeswoman for the state Department of Community Health, said Gov. Brian Kemp has mandated that state agencies 'continually seek ways to make government more efficient and accessible.' Georgia's governor defends Pathways The governor's office defended the enrollment numbers. Kemp spokesman Garrison Douglas said the early projections for Pathways were made in 2019, when the state had a much larger pool of uninsured residents who could qualify for the program. In a statement, Douglas credited the Republican governor with bringing that number down significantly through 'historic job growth,' and said the decline in uninsured residents proved 'the governor's plan to address our healthcare needs is working.' For BeShea Terry, Pathways was a 'godsend.' After going without insurance for more than a year, Terry, 51, said Pathways allowed her to get a mammogram and other screening tests. Terry touts Pathways in a video on the program's website. But in a phone interview with The Associated Press, she said she also experienced problems. Numerous times, she received erroneous messages that she hadn't uploaded proof of her work hours. Then in December, her coverage was abruptly canceled — a mistake that took months of calls to a caseworker and visits to a state office to resolve, she said. 'It's a process,' she said. 'Keep continuing to call because your health is very important.' Health advocates say many low-income Americans may not have the time or resources. They are often struggling with food and housing needs. They are also more likely to have limited access to the internet and work informal jobs that don't produce pay stubs. Republican lawmakers have promoted work requirements as a way to boost employment, but most Medicaid recipients already work, and the vast majority who don't are in school, caring for someone, or sick or disabled. Kemp's administration has defended Pathways as a way to transition people to private health care. At least 1,000 people have left the program and obtained private insurance because their income increased, according to the governor's office. After a slow start, advertising and outreach efforts for Pathways have picked up over the last year. At a job fair in Atlanta on Thursday, staff handed out information about the program at a table with mints, hand sanitizer and other swag with the Pathways' logo. A wheel that people could spin for a prize sat on one end. Since Pathways imposed the work requirement only on newly eligible state residents, no one lost coverage. The Arkansas experiment That's a contrast with Arkansas, where 18,000 people were pushed off Medicaid within the first seven months of a 2018 work mandate that applied to some existing beneficiaries. A federal judge later blocked the requirement. The bill that passed the U.S. House would likely cause an estimated 5.2 million people to lose health coverage, according to an analysis from the nonpartisan Congressional Budget Office released Wednesday. Arkansas Republican Gov. Sarah Huckabee Sanders has proposed reviving the work mandate but without requiring people to regularly report employment hours. Instead, the state would rely on existing data to determine enrollees who were not meeting goals for employment and other markers and refer those people to coaches before any decision to suspend them. Arkansas is among at least 10 states pursuing work requirements for their Medicaid programs separate from the effort in Congress. Republican state Sen. Missy Irvin said Arkansas' new initiative aims to understand who the beneficiaries are and what challenges they face. 'We want you to be able to take care of yourself and your family, your loved ones and everybody else,' Irvin said. 'How can we help you? Being a successful individual is a healthy individual.' ___ Associated Press writers Jonathan Mattise in Nashville, Tennessee, Andrew DeMillo in Little Rock, Arkansas, and Geoff Mulvihill in Philadelphia contributed to this report.
Forbes
08-06-2025
- Business
- Forbes
Big Beautiful Bill Looks To Reverse Affordable Care Act Coverage Gains
The House budget reconciliation bill, dubbed the 'One Big Beautiful Bill Act,' includes large cuts in Medicaid spending that could lead to millions of newly uninsured individuals if the legislation passes in the Senate. The proposed law also contains provisions that alter the Affordable Care Act exchange landscape, potentially leading to millions more uninsured. The Congressional Budget Office estimates that at least five million current marketplace enrollees would lose coverage by 2034. The nonpartisan and policy research firm KFF says the number of people with marketplace plans could shrink even more, by around eight million. Changes in the ACA marketplace would make coverage more expensive, as enhanced tax credits expire, and harder to obtain as open enrollment windows shorten, the paperwork burden for beneficiaries increases and automatic re-enrollment ends. Americans who purchase health coverage through the ACA marketplace exchanges could also soon face higher out-of-pocket maximums in their coverage plans, which means higher cost-sharing. The United States Treasury Department announced in Sept. 2024 that almost 50 million people have obtained healthcare coverage through marketplace exchanges created by the ACA since its enactment more than a decade ago. The Department data show that one in seven Americans have been or are covered by the law. And between President Biden's inauguration in Jan. 2021 and Sept. 2024, 18.2 million Americans got ACA coverage for the first time. Rising enrollment since 2021 has been driven by an expansion under the Biden Administration of premium tax credits to include individuals and families with household incomes up to 400% of the federal poverty level, which equates to $58,000 for a single person and $120,000 for a family of four. Republican lawmakers in both the House and Senate, in concert with the Trump administration, are now looking to reverse some of those gains. The ACA has gone through a tumultuous history since it was signed in 2010. The law has faced repeated calls for repeal by Republicans. For several years following its passage it wasn't a particularly well-liked piece of legislation, Yet the ACA is now more popular than ever, with over 60% of the public having a favorable view of the law, according to KFF. The ACA is a comprehensive reform bill, passed by Congress in 2010, that increases health insurance coverage for the uninsured and implements a wide range of reforms to the health insurance market as well as an expansion of Medicaid, the public insurance program that provides health coverage to low-income families and individuals. Importantly, under the ACA, individuals who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplaces established by the law. The demographics of people on Medicaid are fairly similar to those enrolled in ACA plans. The legislation has its critics. They point to certain flaws in design and implementation, Indeed, in the early years under the Obama Administration, insurers exited in droves and premiums rates increased substantially. Under the first Trump administration, ACA enrollment fell overall while numbers of uninsured rose by more than two million. Following unsuccessful efforts to scuttle the ACA, the president issued executive orders to 'improve ACA market dynamics.' ACA exchanges did stabilize in the latter half of Trump's first term as insurers returned and the rate of premium growth decreased. When Biden assumed office, his administration sought to enlarge the ACA program and counter several of the changes implemented by the first Trump administration that had shrunk its size. The Biden administration was largely successful in terms of increasing the number of people who signed up in the ACA exchanges and reducing the percentage of Americans without health insurance. Troubled times for folks enrolled in the ACA exchanges aren't solely because of possible passage of the budget reconciliation bill. CVS Health announced last month it will pull Aetna out of the ACA marketplace in 2026, leaving about one million people across 17 states searching for new healthcare coverage. Aetna's withdrawal from the marketplace will mark the second time the carrier stepped away from the ACA exchanges. The company left the ACA marketplace in 2018 and came back in 2022. Other carriers left the individual health insurance marketplace in 2017 and 2018 amid uncertainty over whether the ACA would be repealed or replaced. While there isn't the same kind of uncertainty now regarding the ACA's survival, disruption is occurring in the space. This could soon lead to more carriers exiting the market.
