By NextBestFitKeep employer insurance but make it portable
Employers contribute to an individual plan the worker owns (an ICHRA-style account), so coverage moves with the person.
Draft decision:RejectedConfidence: high · not yet reviewed
Unneeded once coverage is decoupled from jobs.
Review ledgerHow this path connects
This path
Keep employer insurance but make it portable
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Expand ICHRA so any employer can fund individual coverage tax-free
- Strengthen individual-market rules (risk adjustment, reinsurance)
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Job lock: people stay in jobs to keep insurance
Employer contributions fund an individual plan owned by the worker, allowing coverage to move with the person. This preserves employer funding with little disruption.
What it creates or worsens
- Concentrates costly patients in some plans
Moving workers into individual plans may leave individual-market risk pools sicker.
- Solves only part of the problem
Employer-funded portable plans do not help people without jobs.
Who's affected
Who gains
- People whose job, income, or home changes
- Job lock: people stay in jobs to keep insurance: Would-be founders, early retirees, and caregivers stay in jobs to keep insurance.
Who loses
- Employers
- Job lock: people stay in jobs to keep insurance: Benefits help employers keep workers who would otherwise leave.
- Health insurers, brokers, and their shareholders
- Job lock: people stay in jobs to keep insurance: Insurers and brokers sell group coverage through employers.
Other ways to soften the losses
- Strong individual-market rules (community rating, risk adjustment) so the pool stays healthy
Where it has been tried
- U.S. ICHRA (2020): Employers may fund individual-market coverage tax-free.
- United States: In 2025, 4% of U.S. firms offering health benefits and employing at least 10 workers funded individual-market insurance for some employees.