A healthcare system without real options is like a menu with one item—take it or leave it. But when it comes to our health, ‘leaving it’ isn’t an option. Choice among health insurance options is both necessary and beneficial. The Granite State has seen the benefits that come from having choices. According to the NH Insurance Department, 2024 Fall open enrollment in the individual healthcare marketplace showed record enrollment of 65,117 Granite-staters. This is a 19.4% increase over 2023 and was driven in part by the entrance of a new carrier, Wellsense, into the individual marketplace space.
While individuals have additional choices the same cannot be said for the primary place most people receive their health insurance coverage—the group insurance space. There are almost 300,000 people in NH who receive health insurance through their employers. Large employers have little difficulty in offering health insurance choices to employees. But, NH is a state dominated by small employers—more than 136,000 of them, according to the U.S. Small Business Administration. What would happen if these small business employers could not find and retain employees because they can’t afford health benefits?
More Turning to Individual Coverage HRAs
On a national level, the percentage of small businesses offering health insurance has been declining over the past decade. In 2021, only 31.9% of all small employers offered health insurance to their employees compared to 43% in 2008, according to the Center on Health Insurance Reforms. The need for choice coupled with the decline of small employers able to shoulder the cost of traditional small group health insurance plans leaves many small employers struggling.
That is the challenge the Individual Coverage Health Reimbursement Arrangement (ICHRA or more commonly, HRA) was created to address. ICHRA, a health reimbursement arrangement first available in 2020, allows employers to reimburse employees for a portion or all of their health insurance premiums that they purchased on their own.
ICHRAs have quickly grown in popularity, with a 171% increase nationwide between 2022 and 2023 of employers offering these plans, according to the HRA Council and Bloomberg Law News. The number of employers with at least 50 full-time workers offering such plans increased 144%.
While ICHRAs can serve as a viable alternative to traditional health plans, education is still needed. It gives the employee the ability to select a health plan from the marketplace that works for them rather than the employer choosing one for them. For instance, according to a recent survey by tech software company Softheon, just two in 10 workers even know about the ICHRA. So, while new to the scene, the ICHRA can grow to play a pivotal role in the ability of both small and large NH employers to attract and retain employees.
Ronald J. Plocinski is founder and owner of The Integrity Agency in Dover, which offers individual and group health insurance. For more information, visit theintegrity
agency.org.
