ICHRAs need better individual health insurance options, actuaries warn
Will issuers improve quality enough to meet employer plan standards? Maybe so.
Individual coverage health reimbursement arrangements, or ICHRAs, could help fix quality problems in the individual major medical insurance market.
Daniel Cruz and Greg Fann, actuaries at Axene Health Partners, make that prediction in a paper distributed by Paragon Health Institute.
Paragon is a think tank, or independent research center, that describes itself as non-partisan but that has had close ties to the Republican Party.
The ICHRA is a relatively new kind of health account. An employer can use it to give workers cash they can use to buy their own health coverage.
Cruz and Fann see an important obstacle to ICHRA expansion: The individual health insurance policies available in many markets are terrible.
Today, most U.S. residents with individual health insurance use Affordable Care Act premium tax credits to buy coverage through ACA public exchange programs.
The ACA subsidy structure encourages consumers to buy the cheapest possible coverage, without thinking about the provider networks or other quality indicators, according to Cruz and Fann.
“The percentage of individual market consumers enrolled in plans with broad provider networks declined from 36% to 11% between 2014 and 2023,” the actuaries write.
Over the same period, the percentage of individual market enrollees in relatively flexible preferred provider organization plans fell to 17%, from 50% in 2014.
Related: Size of physician networks varies widely among ACA Marketplace plans, study finds
Federal laws and regulations have set four main “metal levels,” or coverage richness categories, for ACA policies, ranging from the top, platinum level, which covers about 90% of the actuarial value of a basic benefits package, down to the bronze level, or a plan that covers about 60% of the actuarial value of a basic benefits package.
Most consumers buy whatever plan is cheapest, whether that’s a silver plan or, because of the quirks of exchange plan subsidies, a gold plan, Cruz and Fann note.
The actuaries suggest that increased use of ICHRAs could reverse the current rush to hollow out individual major medical insurance policies, by encouraging insurers to offer individual policies that offer the kind of coverage available through typical employer-sponsored health plans.