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ICHRAs Create a System of Haves and Have-Nots 

Keep US Covered posted on March 9, 2021 

The new Individual Coverage Health Reimbursement Arrangement or ICHRA system – the result of a Trump-era regulation – invites workforces to be divided and provided different types of health insurance coverage. Some employees receive typical employer-sponsored benefits, while others (likely those who cost more to insure, health experts have warned) are forced to find their own coverage on the individual market, worsening the disparities in the American health care system. 


Instead of a more equitable health care system, this creates coverage haves and have-nots in the workplace. It’s rooted in a fundamental unfairness that accepts that some people are worthy of good coverage, while others only deserve something less.  


Here’s the coverage disparity working Americans can expect as a result of the harmful policy: 

HAVES (typical insurance)

  • Seamless benefits – employers do the legwork for their employees in choosing health plans; employees just have to enroll.

  • Quality, comprehensive coverage – employer-sponsored plans generally have the strongest coverage due to increased buying power.

  • Cost-effective coverage – buying coverage for a group of employees, particularly large groups, helps to keep costs down for employers and employees, especially compared to buying insurance on the individual market. 

  • Bigger coverage networks – with better coverage comes more expansive networks of doctors and care providers available to workers.

  • Fairness and equity – employees are treated the same and receive the benefits they’ve earned.

HAVE-NOTS (forced onto ICHRAs)

  • On their own to buy insurance – employees must research and buy their own insurance on the individual market and are then given a voucher for their plan, up to a set limit.

  • Lower quality coverage – the ACA has improved the quality of what’s available on the individual market, but workers buying insurance on their own will inevitably end up with weaker coverage than what they would typically have.

  • Higher costs – individual plans tend to cost more than comparable employer-sponsored plans. And if the ICHRA plan chosen exceeds the reimbursement limits set by the employer, workers are left to cover that added expense out of pocket. Individual plans also tend to cover less, which could lead to workers paying more for the care they need.

  • Limited coverage networks – individual plans have smaller networks, meaning workers who need care have fewer care options and less convenience.

  • Opens the door for discrimination – some employees, or types of employees, are singled out to receive worse benefits than their fellow workers at the same company.


Dividing up workforces and doling out unequal health benefits only serves to exacerbate disparities in the American health system. We can prevent the existence of health coverage haves and have-nots by reversing the ICHRA policy. 

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