The decisive moment for employer health benefits: How a “large bill” changes employer health care

On May 13, 2025, the U.S. House of Representatives’ Ways and Means Committee proposed a bill aimed at expanding the 2017 tax cuts. The settlement bill currently under consideration by Congress for several exciting provisions in employer-sponsored health care, the position is a consumer at the center.

“One Large Bill” will enable personalized insurance models for the Health Reimbursement Arrangements (ICHRAS) (ICHRAS) that transforms employers’ health benefits into legal options, customized health options and personal care expense arrangements).

The proposed shift represents a step towards more personalized and flexible healthcare benefits, which is in line with the moment of today’s workforce. While the basic concept remains the same – reimbursement of employer-funded individual coverage – the bill proposes enhanced features including simplified notice periods and the possibility of exchange pre-tax premium payments.

These regulations can usher in a new era in which employees have greater control over their healthcare choices and employers can provide quality benefits in a more cost-effective and effective way.

Improve small business benefits

Small businesses employ half of the U.S. labor force, accounting for 43.5% of U.S. GDP, according to the U.S. Chamber of Commerce. However, only 30% of small businesses offer health insurance, down from 47% in 2000 – the cost prompted many small employers to abandon their health benefits.

The proposed bill introduces a new tax credit designed to prevent small businesses from pricing from health benefits. Businesses with less than 50 full-time employees with an elective arrangement can receive a two-year tax credit of $100 per month for each registered employee ($50 per month for the second year).

We have seen work on small business tax incentives in Indiana, and other states are considering similar legislation. We believe and hope that this will provide small businesses with more opportunities to support their employees.

Increased affordability and reduced management burden

A large bill proposes to allow pre-tax payments for personal health insurance premiums purchased on exchanges – currently available for Medicare or non-exchange through the cafeteria program only. This is a major shift and represents a real savings for employees.

By allowing pre-tax payments, the effective cost of health insurance premiums will reduce employees, thereby increasing appeal and affordability for redemption-based coverage. Employers will benefit from lower payroll taxes and more attractive benefits to help recruit and retain talent.

The bill can also reduce the employer notice period from 90 days to 60 days. The notice period is the number of days before the start of the program and the employee should receive information about the HRA, including the amount of USD and whether the offer is extended to the dependent. Simplified notifications may ease administrative burdens and be subject to employers who consider the 90-day requirement to be a pain point.

Powering health savings accounts

The bill includes some exciting provisions on Health Savings Accounts (HSAs), which combines a high deduction of Health Insurance Plan (HDHP) with a tax-promoted savings account. By redefining HDHP to include any bronze or catastrophic plans in a single market, Medicare Part A, and certain direct primary care (DPC) arrangements, the number of HSA-compatible programs may breed.

A large beautiful bill also expands the costs that HSA funds can pay, and the possibilities of sports expenses such as gym membership and at-home fitness equipment may be reimbursed. Given that the list of qualified medical expenses for HSA and ICHRA is the same, ICHRA employees cover reimbursement of qualified expenses and will also benefit.

Encouraging the U.S. public to stay healthy is a common sense step towards controlling the costs of individuals, employers, and the healthcare system as a whole – we can all fall behind.

What’s next for a big bill?

Health insurance is just one aspect of the larger bill being considered. We know this is a partisan bill; however, this is exactly the fairways of Ichra and the ACA. HRAs have been popular on both sides of the aisle since its introduction. They bring more lives to individual markets, which is an important focus for Democrats and provide consumers with choice and flexibility – Republicans stand behind. The evolution of ICHRA integration selection arrangements promises to create a health care system where patients have more agencies where they motivate providers to provide high-value, patient-centric care and better coordinate services to meet the individual needs of each consumer.

Although there are still a lot of details that surface in the air and a long signature journey in the Oval Office, I’ve been following this. Employers, employees and lawmakers on both sides of the aisle recognize the benefits of expanding access to the HRA. Whether or not a large bill is passed in its current form, Congress should not miss the opportunity to codify fish into law and provide a real choice for every American in terms of its health care.

Jabin Botsford/The Washington Post via Getty Images

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