In April 2025, the HRA Council submitted an official response to the Centers for Medicare & Medicaid Services (CMS) regarding the proposed rule titled “2025 Marketplace Integrity and Affordability Proposed Rule” (CMS-9884-P). This proposed rule would introduce significant regulatory changes to the operation of the individual market, including elements with potential implications for employers and employees using ICHRAs and QSEHRAs to access health coverage.

The Council’s letter, submitted via Regulations.gov, aims to ensure that the growing ICHRA ecosystem—which now includes large and small employers, brokers, TPAs, and digital health insurance platforms—can continue to thrive under policies that safeguard both integrity and access.

This official comment letter was crafted with input from HRA Council leadership and members, and reflects deep industry experience across all 50 states. It underscores the importance of preserving ICHRA and QSEHRA accessibility, efficiency, and affordability amid regulatory changes.

Here are some key takeaways from our response:

• ICHRA continues to work successfully as a modern alternative to group coverage with strong adoption across employer sizes, and more than 600% growth since its inception.
• Proposed regulatory changes could create unintended consequences such as administrative burden, employee confusion, and barriers to effectuation—particularly regarding shortened Open Enrollment Periods, premium payment windows, and new verification rules for SEP eligibility.
• The Council recommends deferring some implementation timelines (e.g., OEP changes) to 2027, to allow for proper operational updates and employee onboarding.
• The Council urges CMS to consider exemptions or tailored compliance measures for ICHRA/QSEHRA enrollees, given their inherently lower fraud risk and employer-directed nature.
• Stability in individual market tax credits is essential to support robust plan options for employees using ICHRA, especially as employers shift from group to defined contribution models.
• Employers must be protected from liability linked to employee past-due premiums, which could otherwise threaten their ability to offer health benefits through ICHRAs.
• We appreciate CMS's commitment to integrity and look forward to continued dialogue to ensure these important innovations in employer-sponsored insurance remain a viable, growing option for America's workforce.

Click here to read the full letter.