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Pushed Onto ICHRAs, Workers Will Have Access to Fewer Doctors

Options for Care Not Equivalent to the Health Care They Had

Last week, we examined the financial hit facing American workers who will have their current health care replaced by Individual Coverage Health Reimbursement Arrangements (ICHRAs) – estimated to be 1.5 million by the end of 2022. This week, we again leverage Avalere Health’s report on ICHRAs to understand the differences in coverage those people can expect.


Access to quality coverage is critical to the Biden Administration’s goal of addressing health inequities. If more Americans are able to receive the care they need from doctors of their choice, better health care outcomes will follow. But not all coverage is equal, as Avalere’s analysis reveals, and more people will find fewer options available to them.


Not only will workers losing their traditional job-based insurance for an ICHRA plan face higher out-of-pocket costs, they will also have to endure…


Access to Fewer Doctors


Workers forced to transition onto an ICHRA plan will likely have access to coverage in a narrower provider network. That means fewer doctors who accept that kind of insurance. As Avalere’s analysis states: “Individuals who shift from group health plans to ICHRAs are likely to have access to fewer providers.” Specifically, primary care physicians’ participation in ICHRA plans would be 9 percent lower than for group health plans, the kind most often provided at work. And that gap is bigger in some states.


For workers with more significant health care needs, ICHRA plans may be even more detrimental. Compared with traditional job-based group health plans, Avalere found that ICHRA plans cover:


  • 42% fewer cancer and cardiac specialists

  • 32% fewer mental health and primary care doctors

  • 24% fewer hospitals


More serious conditions that require the expertise of a specialist can occur at any point in someone’s life. As workers age, health problems can occur more frequently and have bigger consequences. Under an ICHRA plan, workers facing those scenarios would have fewer options than under their existing coverage. To see a doctor outside of network would likely be prohibitively expensive for most. And those who unfortunately live with chronic illnesses will face the additional stress and costs smaller provider networks bring. They deserve the quality coverage they earned instead of having it replaced by ICHRAs.


Lost Benefits


Job-based insurance is also increasingly making available popular workforce wellness initiatives that are not often included in an ICHRA plan. As Avalere’s analysis points out: “According to the KFF Employer Survey, 58% of small firms and 83% of large firms offer a program in at least one of the following areas: smoking cessation, weight management, and behavioral or lifestyle coaching.” Not only would many workers on an ICHRA lose access to these benefits, moving workers onto ICHRAs removes them from this pool and could negatively impact the efficacy of some of these programs, which in turn effects the overall health and wellness of workers.


Bottom Line


Replacing the health care American workers have with an ICHRA plan that comes with access to fewer doctors is unfair and runs counter to the goals of health equity. For 1.5 million workers and growing, their choices about which doctors they can see will be significantly limited. These plans promote disparate health outcomes within the workplace and potentially lead to worse health for those forced onto these plans. The Biden Administration should act now to reverse the flawed policy that created ICHRAs and protect the quality coverage American workers have earned.


To read the full report and learn more about our campaign to encourage the administration to rollback harmful ICHRA and junk insurance policies put in place under the previous administration, go to

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