ICHRA Brings Consumer Choice And Market Pressure To Employer Healthcare, Says SureCo Exec

ICHRA isn’t a niche workaround for small employers. It’s a structural response to a deeper failure in American healthcare: a market where employees aren’t the real buyers. When purchasing power is removed from the end customer, inefficiency compounds and costs rise, year after year. By shifting choice and control back to individuals, the Individual Coverage Health Reimbursement Arrangement reintroduces real consumer behavior into employer-sponsored healthcare, creating pressure the system hasn’t felt in decades.

Few executives have spent as long inside this problem as Erik Wissig, Chief Operating Officer and Chief Financial Officer at SureCo. Long before ICHRA entered the regulatory mainstream, Wissig was working to redesign how employer-sponsored healthcare functions. As Co-Founder and CFO of Hixme, he helped pioneer the model that ultimately became the Individual Coverage Health Reimbursement Arrangement, laying the groundwork for a benefits structure built around individual choice rather than employer selection.

"This isn’t a niche strategy limited to small employers. ICHRA is a catalyst that opens the door for an employer-supported movement that nudges the entire healthcare market in a better direction," says Wissig. For decades, the tax code favored traditional group plans. That began to change with the 2019 ICHRA regulation, which allowed employers to provide pre-tax Health Reimbursement Arrangements for employees to buy their own individual coverage.

• The power of choice: At its core, Wissig sees ICHRA as a mechanism for reintroducing basic market dynamics into a system that has long operated without them. "ICHRA is a catalyst because it empowers the end purchasing consumer," he explains. "Once people have real choice, the market has to respond by creating products they actually want, delivering on that experience, and giving them reasons to stay."

• From decider to supporter: By creating tax parity, the rule unlocked a fundamentally different way for businesses of any size to provide benefits. "It puts the individual market at tax parity with the group market, so an employer doesn’t have to wrangle with that anymore. You shift from having to decide for your employees to arming them to make their own decision, while simply supporting them financially," Wissig continues.

For businesses, this represents a new approach to health benefits that offers a path toward greater financial predictability. In a group plan, pricing is tied to that specific group’s health, creating sharp and unpredictable cost increases if even one or two people have a high-cost year. By moving employees into the much larger and more stable individual market risk pool, companies can achieve a more predictable budget.

• The 401(k) of healthcare: "For a business, it creates what we like to call a 401(k)-style contribution structure, where they’re giving people pre-tax dollars to apply to their healthcare," Wissig says. "That lets employers focus on setting a predictable contribution instead of managing plan selection year after year." The approach replaces volatile group-plan pricing with a defined contribution model that improves budget predictability while still expanding employee options.

• Local advantage: A distributed workforce gains the ability to select from a marketplace of local options, which often includes desirable regional hospital systems that a single group plan might exclude. "In LA, people here might want access to Cedars or UCLA. But for people in Philadelphia, for example, UPenn might be important. You can tap into that because the carriers establish their networks locally."

• Confidence is key: But the model requires a fundamental change in thinking for HR departments. Their role evolves from managing a single relationship with one insurance company to facilitating dozens of individual employee choices. Success, Wissig suggests, hinges on building a new kind of trust through transparency and partnership, which helps teams stay compliant with affordability rules without getting lost in the details. "This model works when HR doesn’t have to control every step, but also isn’t left in the dark. What matters is having visibility, knowing what’s happening when something goes wrong, and having confidence that it will be handled."

As adoption grows among employers, the individual becomes the true purchaser in healthcare, introducing a new kind of pressure to the system. Insurance carriers are forced to compete on products people actively choose, and providers are compelled to participate in the networks those choices elevate. With regulatory stability in place, this market-driven movement begins to correct the imbalance at the center of employer-sponsored healthcare.

"ICHRA has opened the door for an employer-supported movement that is nudging the entire healthcare market in a better direction," Wissig concludes. "This goes beyond saving money. It’s about giving people the confidence to use their money more effectively, understand what they’re paying for, and adjust when their needs change."