top of page

With the House Flipped, Two Executive Actions President Biden Can Still Take to Advance Health Equity

December 13, 2022

No longer having Democratic control of Congress shouldn’t stop the President’s health agenda. Executive action can advance health equity and undo harmful Trump-era policies like ICHRAs and junk insurance.


Despite losing the Democratic majority in the House of Representatives, President Biden still has a meaningful opportunity to carry out his health care agenda and protect quality coverage for working Americans and their families. He can do so through simple executive action, without the help of Congress. Two steps his administration can take today: ending Individual Coverage Health Reimbursement Arrangements (ICHRAs) and rolling back former President Trump’s expansion of Short-Term Limited Duration Insurance – also known as junk insurance. ICHRAs leave American workers vulnerable to weaker coverage and open the door to workplace discrimination and junk insurance, which creates the potential for patients to get sky-high medical bills.


Rolling Back ICHRAs

The Biden Administration can ensure American workers maintain the high-quality coverage they earned. ICHRAs, created by the previous administration, approved a system that divides workforces into classes, with some employees getting traditional coverage through their employer, while others get a stipend and have to fend for themselves on the open market. This takes away the coverage workers have earned, replacing it with coverage that may be costlier, inferior or harder to find. Another pressing risk is that, by dividing workers into classes, ICHRAs introduce the possibility of discrimination in the workplace. To quote Elizabeth Fairchild of Business Forward, one of Keep US Covered’s campaign partners: “[this approach is] bad for employees and bad for businesses trying to remain competitive in the current labor market.” Read more in Benefits Pro.


An Avalere Health analysis found 1.5 million American workers will lose their current health insurance for an ICHRA plan by the end of this month. The stipend-based system means:


President Biden should take immediate action to end ICHRAs. Doing so also strengthens the Affordable Care Act by protecting risk pools from the potential influx of high-cost consumers dumped by employers onto the open market.

Taking on Junk Insurance


President Biden can keep his health coverage promises by rolling back ICHRAs – but he shouldn’t stop there. Expanded short-term limited duration insurance (STLDI), also known as junk insurance, is another harmful Trump-era health care rule that President Biden should reverse – and, like ICHRAs, he can do so without Congress. The Trump Administration expanded the definition and duration of junk insurance so that this short-term insurance covers not just three months between jobs, but up to three years. This flooded the market with low-quality insurance plans that left working Americans unknowingly vulnerable to huge medical bills and access to fewer doctors. Junk insurance provides neither health care peace of mind nor the promise of affordable care. These coverage options don’t have to comply with the patient protection provisions in the Affordable Care Act, such as coverage for pre-existing conditions. They also are notoriously skimpy, leaving patients hit with a surprising diagnosis underinsured and vulnerable to soaring medical bills.


Bottom Line


Now is the time for President Biden to take executive action on ICHRAs and junk insurance. Despite losing a Democratic House, President Biden still has the power to ensure that working Americans get – and keep – the quality health care coverage they deserve. Reversing ICHRAs and junk insurance would be easy wins for the administration and advance affordability and health equity.


To learn more about Keep US Covered and its partners’ work to educate policymakers on these regulations and the social determinants of health, visit or follow the campaign on Twitter and Facebook.

bottom of page