Glad you asked.
Starting this January 1, employers may satisfy their "employer mandate" under the ACA by establishing Individual Choice Health Reimbursement Arrangements for their employees. I'm a huge fan of ICHRAs, and have advocated for them for several years now as a potential silver bullet to fix the ACA. Thanks to Trump, they're now the law!
What's an ICHRA? Well, let's first identify the problem - smaller employers have difficulty obtaining affordable, comprehensive group health insurance. Some resort to desparate measures, turning their workforces over to PEOs just to pick up the ability to join an affordable group. Moreover, an employer with at least 50 full-time employees is compelled to offer group health insurance, or pay the ACA "employer mandate" penalty. You've no doubt read of employers switching workers to part-time status to get in under the 50-fulltime employee limit. It's a huge headache for smaller employers - and their employees are often the victims.
Meanwhile the ACA exchanges have underperformed expectations, with most enrollment coming from folks with health issues who simply must have insurance, no matter the cost. And ACA policies, if you don't qualify for a subsidy, aren't cheap, usually have huge deductibles, and limit choice because of narrow networks.
What the ACA marketplace needs to succeed are more younger, healthier lives.
Enter the ICHRA. For the first time, employers can satisfy their ACA employer mandates without having to obtain costly health insurance. They can, instead, establish health reimbursement accounts (HRAs) to which they contribute for their employees, which their employees can then use to purchase individual policies on the ACA exchange.
This kills two birds with one stone. Employers now have cost certainty and don't have the expense of administering a traditional health care plan. Their commitment consists of the dollars they use to fund their employees' HRAs. And the employees take these dollars and their younger, healthier lives and purchase individual policies from the exchange. The affordability of policies on the ACA exchanges has always been hurt by adverse selection. But now there's the potential of millions of new lives purchasing these policies, broadening the risk pool for insurers and lowering premiums. And encouraging more competition in the ACA insurance marketplace, leading to the return of broader networks.
I have high hopes for these new ICHRAs. Forget Trump's rhetoric; this is a hugely beneficial change for the middle class and the thousands of smaller companies that employ them. Yes, I think Trump may well have saved the ACA.