Lately, the healthcare policy conversation has been consumed by debates over MFN pricing, vaccine mandates, MAHA initiatives, and more. While these issues demand attention, I remain an optimist: 2026 offers a critical window for a broader, more substantive discussion about the core challenges facing American healthcare. As millions of Americans navigate open enrollment, a familiar question echoes: “Am I truly getting the specific coverage I need?” For too many, the answer is a resounding ‘no.’ Despite ever-increasing premiums, satisfaction often lags, and the traditional employer-sponsored health insurance model, while foundational, is showing its age.
The status quo in healthcare, characterized by rising costs and a “one-size-fits-all” approach to coverage, is no longer acceptable. In almost every other aspect of our lives —from how we customize our technology to how we manage our finances —we demand personalization and choice. Yet, when it comes to one of the most critical decisions – our health – we often settle for limited options dictated by others.
It doesn’t have to be this way. There is a powerful, yet underutilized, tool to fundamentally reshape this dynamic: Individual Coverage Health Reimbursement Arrangements, or ICHRAs. I witnessed firsthand the excitement and potential when these innovative arrangements were first drafted during my time at HHS – when I served during the first Trump administration. ICHRAs represent a significant step towards a more consumer-centric healthcare system. Think of it as the 401(k) model of health insurance: employers provide a defined contribution, and employees use those funds to purchase the individual health plan that best suits their unique needs and preferences.
The 2019 final rule projected 11 million Americans to be enrolled in ICHRAs by 2024, yet current numbers fall far short of that promise. This gap isn’t due to a flaw in the concept, but rather issues of timing, lack of education, and other challenges. Change can be nerve-racking, especially for something as personal and priority as healthcare. But the alternative is stagnancy, and the status quo isn’t tenable. Through my work with the Washington Health Innovation Council, I’ve had recent conversations with leading experts who understand the promise of ICHRAs and share this vision of innovation. ICHRAs can still reach their full potential, and there are ways to instill confidence in the employers and employees considering ICHRAs.
First, legislative codification of the rule, such as the CHOICE Act, would provide the certainty many companies may need to consider ICHRA as a viable option. In addition to federal legislative action, states providing innovative incentives have also accelerated adoption. States like Indiana, Ohio, Texas, and Georgia are demonstrating how tailored policies can encourage employers to offer ICHRAs, providing a blueprint for others. Policymakers must explore regulatory adjustments that expand choice and address concerns, fostering an environment where ICHRAs can thrive.
Second, robust education is paramount. Brokers, who are critical conduits of information for businesses, should be well-informed and experienced in ICHRA implementation as its popularity grows, and employers look to their expertise. Employers and employees alike need clear, accessible information to understand the mechanics of ICHRA and the benefits of personalized choice, ensuring they can confidently navigate this coverage option.
Third —and perhaps most powerfully —we need to lead by example. Many I’ve spoken with believe the most impactful catalyst will be companies and organizations that transparently embrace ICHRAs and share their success stories. We’ve seen state exchanges, like Connect for Health Colorado, adopt ICHRAs for their own employees.
Organizations like Paragon Health Institute, led by Brian Blase, who oversaw ICHRA’s creation with the White House’s National Economic Council, also utilize this model for their employees, demonstrating its viability. Just recently, Centene announced it would be moving employees in Indiana to an ICHRA model, a public demonstration of confidence from a major player. These examples can serve as models and showcase the profound cultural shift towards employee empowerment, and the benefits both to employers and employees that could ignite a wave of adoption.
ICHRAs offer a tremendous opportunity to address many of the challenges healthcare currently faces. Let’s not accept a system where people pay for less satisfaction, limited choice, and benefits they may not need. Instead, let’s embrace innovation, empower individuals, and work together to build a future where every American can access and select the personalized, high-quality health coverage they deserve. The time for a truly consumer-driven healthcare experience is now.