Making Healthcare Affordable
- Tori MacFarlan
- 2 days ago
- 2 min read
Eliminating barriers for small and mid-sized employers as well as encouraging consumer engagement is the free market solution to growing costs.
House Select Committee on Healthcare Affordability
There are indications that health plan marketplace is producing new designs.
Level-funding is not new, but a wave of employers switching from fully-insured coverage to level-funding is evidence that the marketplace is offering some flexibility. From 2019 to 2025, the percentage of small employers nationally offering healthcare coverage to their workers that opted to use level-funding rose from 7 percent to 37 percent.
Several plans (e.g., UnitedHealthcare’s Surest) now offer deductible-free coverage with co-pays varying depending on the track record of value provided by the provider the enrollee chooses to see. These plans offer enrollees a menu of in-network providers that displays the applicable co-pay for a provider, which the enrollee can take into account when making an appointment for care.
The company Curative offers options under which enrollees have no deductibles or co-pays for in-network medical care, provided they have a baseline checkup every year.
The insurer Sidecar uses market RFP with a shared savings component to encourage consumers to shop for healthcare.
Individual Coverage Health Reimbursement Arrangement (ICHRAs) have seen considerable growth. According to a 2026 report, the budding ICHRA market doubled from 2025 to 2026. These arrangements allow for employers to contribute pre-tax dollars that can be used to reimburse employees for health insurance premiums and other healthcare-related expenses. Employees benefitting from an ICHRA can shop for individual coverage that best suits their needs, and employers can benefit by having defined costs for the healthcare coverage they offer. It is worth emphasizing that employees can add their own money on top of the amount their employer reimburses them, and in fact many do; a recent survey on ICHRAs found that the median employer allowance to employees was $459 per month, but the median premium selected by employees was $567. A possible headwind for ICHRAs is that the ACA exchanges’ risk pool is not favorable. If ICHRA adoption increases, however, the risk pool will likely improve, which could create a virtuous cycle of continuing adoption that lowers premiums.
Read the full testimony in the link above.
