ICHRAs now showing up on standard employer benefits option menus

The level of ICHRA plan interest and adoption is lower at large and midsize employers, but the interest level at those employers "is accelerating at a faster pace than we anticipated," Uretsky said. "We saw adoption in this market grow."

What it means: The percentage of workers who use the employer cash in ICHRAs to pay for individual or family health coverage may still be low.

But, for the employers that work with Gallagher — one of the biggest insurance brokers and benefits consulting firms in the United States — the percentage that see ICRHA plans on their health coverage options menus is now high.

What Uretsky is saying about ICHRA plan interest supports what Affordable Care Act public exchange program officials in Connecticut have said about employer ICHRA interest.

Related: ICHRA push reinvigorates employer health market in Connecticut

One top question now is how well employer interest in ICHRAs will translate into 2027 ICHRA plan adoptions.

The backdrop: The administration of President Donald Trump, many Republicans in Congress and some Democrats in Congress have supported ICHRA program expansion.

Trump seems to be echoing the ideas of ICHRA supporters when he talks about the view that putting cash in the hands of workers and having workers buy their own coverage will lead to workers having better, more affordable coverage.

But one factor slowing employer adoption of ICHRAs may be turmoil in the individual major medical market.

Another may be lack of congressional action. Although Republicans in Congress say they like ICHRAs, they failed to put a provision establishing a statutory framework for ICHRAs in either the One Big Beautiful Bill Act or the Consolidated Appropriations Act of 2026.

Gallagher's ICHRA approach: Gallagher has been working with StretchDollar, a company with backing from Oscar Health, to support the ICHRA plans it sells.

Offering ICHRA plans gives employers a new way to control costs while expanding employees' coverage options, Uretsky said.

The pipeline: Today, the percentage of employers with in-depth knowledge of ICHRAs is still low, but employers' level of basic ICHRA awareness has "improved meaningfully, year over year," Uretsky said.

Uretsky said the kinds of employers showing the strongest interest in ICHRA plans tend to be multi‑state employers, employers with headcounts that vary widely over time, and employers facing big traditional health coverage renewal price increases.

"We also see interest from organizations seeking greater alignment between benefit spend and workforce diversity," Uretsky said.

The Gallagher clients that rule out ICHRA plan adoption often cite issues such as concerns about complexity for employees, a preference for sticking with traditional group coverage pricing, and worries about how long setting up an ICHRA plan might take.

ICHRA readiness: At this point, Uretsky said, the employers that are happy with their ICHRA plans tend to be those that have finance and human resources teams spend time on designing the plans and developing employee education efforts.

Working with a good ICHRA advisor, choosing a strong technology support platform, and making sure that all players know who is supposed to do what are also important, he said.

The employers that are least happy with their ICHRA plans tend to be those that adopted ICHRA plans at the last minute and set up their plans in less than 45 days, Uretsky said.