Latest / Becker’s Healthcare Podcast / Why ICHRA Is Gaining Momentum With Employers and Public Entities

Transcript

Why ICHRA Is Gaining Momentum With Employers and Public Entities · Becker’s Healthcare Podcast

• 0:02
  This is where health insurance leadership comes together.
• 0:05
  Becker's fourth annual spring payer issues roundtable brings
• 0:08
  together over 400 payer and health plan executives
• 0:12
  and more than 100 speakers to Chicago April.
• 0:16
  This year's event includes keynote conversations with the
• 0:19
  industry's top leaders and former president George W.
• 0:23
  Bush. For the full agenda and event details,
• 0:25
  visit beckershospitalreview.com
• 0:27
  and click on the events tab in the
• 0:29
  upper right. We're looking forward to hosting you
• 0:31
  here in Chicago.
• 0:34
  Hello, everyone. This is Jacob Emerson with the
• 0:36
  Becker's Pay Your Issues podcast. Thrilled today to
• 0:38
  be joined by Jack Hooper, who is the
• 0:40
  CEO and cofounder of Take Command. Jack, thanks
• 0:44
  so much for taking the time to be
• 0:45
  with me on the podcast today.
• 0:47
  Jacob, thank you so much for for having
• 0:49
  me on.
• 0:51
  Excited to talk with you today.
• 0:53
  Likewise, Jack. Appreciate you taking the time to
• 0:55
  chat with us. Before we get started, can
• 0:58
  you first tell the audience a little bit
• 1:00
  about yourself, your background in terms of your
• 1:02
  career, anything involving health care, and then give
• 1:05
  us an overview of your your current role
• 1:06
  at Take Command and exactly what you all
• 1:08
  do.
• 1:09
  Sure.
• 1:10
  So I'm I'm Jack Hooper. I'm the CEO
• 1:13
  and founder of Take Command.
• 1:15
  So Take Command, we are a software platform
• 1:18
  that helps employers
• 1:20
  administer the new individual coverage HRA or ICRA.
• 1:25
  You might ask, alright. How does one get
• 1:27
  into being a, ICRA software
• 1:30
  administrator?
• 1:32
  For me, my my career actually started not
• 1:34
  in health care.
• 1:35
  I,
• 1:37
  I joke. I I used to work for
• 1:38
  the federal government.
• 1:40
  I was in intelligence and worked for the
• 1:42
  FBI.
• 1:43
  But now I say, you know, I'm I'm
• 1:45
  even cooler. I work in health insurance now.
• 1:47
  So
• 1:48
  grateful for that background, but but really what
• 1:51
  moved me into health care was was a
• 1:53
  personal experience.
• 1:54
  I have,
• 1:56
  two twin boys that are turning 13 next
• 1:58
  month.
• 1:59
  So
• 2:00
  that's kinda how I mark my milestones.
• 2:03
  And as much of a blessing as they've
• 2:05
  been, they were an enormous surprise for for
• 2:08
  me and my wife. We had just,
• 2:11
  left our jobs and families in Texas and
• 2:13
  moved to Philadelphia for graduate school
• 2:16
  and live living in a nice efficiency apartment
• 2:19
  and found out we were pregnant with twins.
• 2:22
  And, you can imagine the the shock and
• 2:25
  surprise and,
• 2:26
  really my personal journey of trying to figure
• 2:29
  out, okay, how much do twins cost?
• 2:31
  How much in student loans do I need
• 2:33
  to take out,
• 2:35
  to pay for these twins
• 2:37
  is, what got me into health care. So,
• 2:40
  Take Command was initially
• 2:42
  an early player in in kind of the
• 2:44
  ACA
• 2:46
  advising,
• 2:47
  movement of helping people,
• 2:49
  pick and choose a health plan in the
• 2:50
  ACA.
• 2:53
  We stepped into the predecessor to ICRA,
• 2:55
  the QSC HRA,
• 2:57
  and started working with small employers,
• 3:00
  and then actually had a chance to,
• 3:03
  work with,
• 3:04
  regulators,
• 3:05
  during the first Trump administration to help create
• 3:07
  some of the ICRA rules after after broader
• 3:10
  health care reform had failed. So,
• 3:12
  excited to, you know, it's kinda evolution going
• 3:15
  from individual to small business to now with
• 3:18
  ICRA
• 3:19
  working more and more with,
• 3:21
  large employers.
• 3:23
  Sure. Quite an evolution of a career you've
• 3:25
  had then, it sounds like, Jack, from from
• 3:27
  federal government,
• 3:28
  intelligence to
• 3:29
  health insurance. Day it all makes sense. You
• 3:31
  know, maybe there's a bigger plan out there,
• 3:34
  but I'm super grateful. Yeah. Sure. Well, so
• 3:36
  it's clearly it's a personal journey for you
• 3:38
  as well as much as it is professional
• 3:40
  in terms of the background of Take Command.
• 3:42
  And, you know, you mentioned,
• 3:45
  health insurance. It kinda sounded like or at
• 3:47
  least what I've heard from leaders in the
• 3:48
  industry before, when they talk to people who
• 3:50
  aren't in this industry, that it it almost
• 3:52
  seems like it would be very dry. But
• 3:53
  I think you and I both know it
• 3:55
  is it is anything but that. And,
• 3:58
  and it's also going through a a lot
• 3:59
  of change right now. It always has been.
• 4:01
  But right now, as as you know, given
• 4:03
  given the company that you help start and
• 4:05
  oversee, it's it's a it's an incredible time
• 4:08
  for for how this industry and how health
• 4:10
  benefits are changing. And
• 4:12
  that's that's what I wanted to get us
• 4:13
  started about talking today.
• 4:15
  An interesting
• 4:16
  move out of West Virginia.
• 4:18
  There's a county there that recently became one
• 4:20
  of the first public entities
• 4:22
  to drop the traditional group coverage that everybody
• 4:24
  knows in favor of an ICRA through Take
• 4:28
  Command.
• 4:29
  So maybe for our audience who isn't familiar,
• 4:31
  first, Jack, just give us a quick
• 4:33
  overview what is ICRA, and then what's kind
• 4:36
  of the what's kind of the significance here
• 4:38
  of seeing a public entity,
• 4:41
  go go in this direction?
• 4:43
  Yeah. Great question.
• 4:45
  You know, ICRA is a term
• 4:47
  you know, it's it's, six years old now,
• 4:50
  so it became a thing in in January
• 4:53
  2020.
• 4:54
  It stands for the individual coverage health reimbursement
• 4:57
  arrangement or individual coverage HRA.
• 5:00
  I think a lot of health executives, you
• 5:03
  know, early on
• 5:04
  kind of mistakenly
• 5:06
  threw it into the HRA, FSA, HSA category
• 5:10
  of, like, oh, okay. Here's another thing or
• 5:12
  or another twist.
• 5:14
  But but, fundamentally, although it shares the the
• 5:16
  three letter acronym with with, HRA,
• 5:20
  it really is a fundamentally
• 5:22
  new way for employers to think about,
• 5:25
  insurance benefits. So it, you know, I know
• 5:28
  many of your listeners have been around for
• 5:29
  a while, and this this idea of defined
• 5:31
  contribution,
• 5:33
  always seems to have, fits and starts in
• 5:35
  our industry.
• 5:37
  Well, ICRA actually now provides the the rules
• 5:41
  and regulations,
• 5:43
  for defined contribution to be a real thing
• 5:45
  in health care. You know, so what that
• 5:47
  looks like now is employers,
• 5:49
  small, medium, large,
• 5:52
  instead of purchasing a traditional group health plan
• 5:55
  for for their employees,
• 5:57
  now they can offer a defined contribution. So
• 6:00
  kind of this four zero one k style.
• 6:02
  There's a lot of flexibility with, hey. I
• 6:05
  wanna give maybe $300
• 6:07
  a month to my part time employees and
• 6:09
  600 to my full time or different amounts
• 6:12
  based on location,
• 6:13
  or other approved employee classes.
• 6:16
  It creates this really flexible
• 6:18
  opportunities for for employers. It solves a lot
• 6:21
  of the problems that,
• 6:23
  you know, group health plans have dealt with
• 6:26
  in terms of adverse selection or or not
• 6:28
  being able to anything more about remote work
• 6:31
  and being able to cover people coast to
• 6:33
  coast. But it creates this really cool opportunity
• 6:36
  for, individual employees now where, okay, they can
• 6:39
  go,
• 6:40
  purchase a plan in their local market.
• 6:43
  Administrators like Take Command and and others have
• 6:45
  gotten good at helping advise employees on, hey.
• 6:48
  You should pick this plan because it's got
• 6:49
  your doctor in it, or this one's gonna
• 6:51
  cover your prescriptions the best.
• 6:54
  And it creates this
• 6:55
  real real kind of flexible,
• 6:58
  layer of coverage at at two different levels,
• 7:00
  at the employer,
• 7:01
  and then at the the employee level.
• 7:04
  And the the other great thing about it,
• 7:06
  you know, we're super excited to see,
• 7:09
  Monongahela
• 7:10
  County in in West Virginia,
• 7:13
  you know, really be the first
• 7:14
  I know some other, like, municipalities have explored
• 7:17
  ICRA, but this was a a big public
• 7:19
  win for ICRA.
• 7:21
  And, you know, they Mongolia faces the the
• 7:24
  same challenges that a lot of employers do
• 7:26
  of of, hey. We've got rising,
• 7:29
  premiums.
• 7:30
  In this case, we've got a fixed
• 7:33
  tax base or tip or fixed revenue base,
• 7:36
  and absorbing,
• 7:37
  you know, these twenty, thirty, 40%
• 7:39
  increases,
• 7:41
  actually gets really hard. And,
• 7:44
  you know, so ICRA, because it's a fine
• 7:46
  contribution,
• 7:47
  it it does provide more cost control to
• 7:49
  the employers.
• 7:50
  There actually was a an interesting,
• 7:53
  their meeting minutes from from their council meeting,
• 7:57
  came out yesterday, and there's an item in
• 7:59
  it in in the commissioner report.
• 8:01
  Let me find it here real quick.
• 8:03
  Talking about saving $700,000,
• 8:07
  this last year by shifting to ICRA,
• 8:10
  and the the cost that their employees were
• 8:13
  paying, their premiums,
• 8:15
  dropped between about 7%.
• 8:18
  So a huge win just by being able
• 8:21
  to to control the cost
• 8:23
  and and kinda reset the the insurance game.
• 8:26
  And it's really interesting. Those those, figures you
• 8:29
  you stated there, Jack, in terms of some
• 8:30
  of the savings this county will see. And
• 8:33
  and I wonder, you know, you said there's
• 8:35
  other government entities that have been interested in
• 8:38
  ICRA, but this was really one of the
• 8:40
  more the the first or the more most
• 8:42
  public,
• 8:43
  situation that we've seen. So are you seeing
• 8:46
  more interest from from government employers?
• 8:49
  And could we see you know, I think
• 8:51
  fair to say, this is a pretty small
• 8:52
  county in a in a smaller state. So
• 8:54
  where do we are you gonna see at
• 8:56
  some point entire states or or larger,
• 9:00
  counties
• 9:00
  look into something like this?
• 9:03
  You know, I think so. And and I
• 9:04
  think,
• 9:06
  so so, yes, it's still early days in
• 9:08
  ICRA. As mentioned, it's it's six years old,
• 9:11
  which and and our,
• 9:13
  in our industry, it's it's, you know, the
• 9:15
  first inning,
• 9:17
  of of a longer game.
• 9:19
  But but I think, you know, for for
• 9:21
  health plan executives
• 9:22
  thinking about how this could evolve. Right? You
• 9:25
  know, you've got your,
• 9:27
  kinda early mover, early adopters right now.
• 9:30
  Now this county,
• 9:32
  you know, they,
• 9:34
  working with their team,
• 9:35
  they were really forward leaning.
• 9:37
  They were actively looking for solutions,
• 9:41
  and,
• 9:42
  ICRO was a great fit, and and now
• 9:44
  they're gonna recognize those savings.
• 9:47
  You know? And it's it's stories and case
• 9:49
  studies like that that kinda move you from
• 9:51
  the early adopter phase, you know, into the
• 9:54
  more kinda, you know, medium adopter or, a
• 9:57
  little bit more mainstream. So I I don't
• 10:00
  think it's gonna happen overnight,
• 10:02
  but I do think,
• 10:04
  you know, steady over time,
• 10:07
  ICRO is being is gonna become more and
• 10:09
  more mainstream and and commonplace.
• 10:11
  And and as a health plan executive,
• 10:13
  you know, really thinking about, alright, what is
• 10:15
  our ICRO strategy? How do we,
• 10:18
  play offense,
• 10:19
  if we've got opportunities to that? Or how
• 10:21
  do we play defense?
• 10:23
  I you know, ICRA, it's it's sub 1%
• 10:26
  right now, but if you're not thinking about
• 10:28
  it, I think you're you're gonna be a
• 10:29
  little bit behind in the next few years
• 10:31
  Sure. Or getting caught up in the heart.
• 10:33
  Yeah. No. It makes a lot of sense.
• 10:34
  And I think just given some of the
• 10:36
  group
• 10:37
  rates we've seen this year alone compared to
• 10:40
  some of those savings you you mentioned, Jack,
• 10:41
  I think for a lot of entities, a
• 10:43
  lot of employers, it's gonna be hard to
• 10:45
  ignore,
• 10:46
  moving forward. But I also wanted to talk
• 10:48
  wanted to talk about some of the bigger
• 10:50
  context
• 10:51
  here around ICRA and, of course, the ACA,
• 10:54
  and everything that's been going on at the
• 10:55
  federal level. Mhmm. With the expiration of the
• 10:58
  the enhanced subsidies last year,
• 11:00
  no real congressional solution in sight, even if
• 11:04
  that is in the form of going down
• 11:05
  the HSA path, which we've seen.
• 11:08
  Some Republicans really been pushing recently. So preliminary
• 11:12
  enrollment data for the ACA, and I know
• 11:14
  enrollment just ended yesterday, so we don't have
• 11:16
  the final numbers. But it has declined around
• 11:18
  the country. Some states, a lot more than
• 11:20
  others.
• 11:21
  But it looks like as of the start
• 11:23
  of this month in January, about three and
• 11:25
  a half percent decline around the country. So
• 11:27
  I wonder overall how you're thinking about this
• 11:30
  as you look through this data,
• 11:32
  and as as you see, you know, around
• 11:35
  the country, different state marketplaces.
• 11:37
  How is this instability affecting employer interest in
• 11:40
  ECHO right now? Does it change the value
• 11:42
  proposition for workers?
• 11:44
  How are you thinking about all this?
• 11:46
  It's a good good question, Jacob.
• 11:49
  And, you know, we did see a lot
• 11:51
  of employers
• 11:52
  this year were,
• 11:54
  exploring ICRA.
• 11:56
  I'd say they got close to the finish
• 11:58
  line,
• 11:59
  but, you know, some of the political uncertainty
• 12:01
  or market uncertainty is like, well, let's wait
• 12:04
  one more year. Let's let's kinda see how
• 12:06
  things shake out. So,
• 12:08
  you know, we we we've all learned in
• 12:10
  this industry not not to bet on Congress,
• 12:13
  and, you know,
• 12:15
  health care reform gets recast as insurance reform,
• 12:20
  over and over again.
• 12:23
  I I I do think, you know, what's
• 12:25
  encouraging, though, is is the long term,
• 12:29
  and seeing in in a strange way. I
• 12:31
  I I think, you know, we're all hoping
• 12:32
  for some reforms or for,
• 12:35
  the subsidies to be to come back or
• 12:37
  at least tapered down,
• 12:40
  over a period. You know, the the sudden
• 12:42
  shocks to the system are are what kinda
• 12:45
  hurt or or can be be frustrating.
• 12:48
  But we are encouraged, though, and now we're
• 12:50
  hearing Republicans talk about funding CSR payments,
• 12:54
  which,
• 12:55
  you know, would be great because that gets
• 12:56
  money where it's it needs to be for
• 12:59
  lower income Americans and helps bring the you
• 13:01
  know, removes the silver loading problem
• 13:04
  and helps bring premiums down for everyone else.
• 13:07
  You know, ICRA is interesting because it
• 13:10
  it doesn't rely on premium credits. Most ICRA
• 13:14
  recipients,
• 13:15
  because they're getting an ICRA allowance, they're not
• 13:17
  eligible for tax credits. So they're that small
• 13:20
  percentage of the market that's gonna pay full
• 13:22
  freight for for the premium.
• 13:24
  And so anything like CSR payments or,
• 13:28
  other reforms that can bring down that top
• 13:30
  line number are are desirable,
• 13:33
  for ICRA.
• 13:35
  I I was encouraged, though,
• 13:37
  again, as you mentioned, still early days with
• 13:39
  getting numbers in, and and there is a
• 13:41
  decline.
• 13:43
  A big fear I had was, oh, is
• 13:45
  this gonna be the,
• 13:47
  kinda unwinding
• 13:49
  or,
• 13:50
  you know, really damaging to the ACA marketplace.
• 13:53
  I have a feeling that 3% will drop
• 13:55
  a little bit further as as people,
• 13:58
  maybe they don't effectuate their policies fully in
• 14:01
  in January. But we're but we're past the,
• 14:03
  oh my gosh, the ACA is
• 14:05
  falling twenty, thirty percent, and we're gonna see
• 14:07
  big pullbacks and and kinda
• 14:10
  death spiral start,
• 14:12
  activity like we saw,
• 14:13
  you know, a couple years ago in in
• 14:15
  the individual market.
• 14:16
  It does feel like it's stabilized.
• 14:18
  And,
• 14:20
  the encouraging thing talking to some insurance carriers,
• 14:24
  okay. While while individual enrollment may be pulling
• 14:28
  back,
• 14:29
  is ICRA an alternative,
• 14:31
  for them to replace some of those losses?
• 14:34
  So that's where I talk about, you know,
• 14:36
  executives needing that kind of thinking and and
• 14:39
  strategy of, hey. How do we lean in
• 14:40
  here? And if we're if we're a big
• 14:43
  ACA,
• 14:44
  carrier and we're gonna lose some enrollments,
• 14:47
  let's go make it up in the small,
• 14:49
  medium, large business segment with ICRA, to replace
• 14:52
  those individual enrollments.
• 14:55
  Mhmm. And that's an interesting point. I think
• 14:56
  definitely,
• 14:57
  is would is catching the ear of a
• 14:59
  lot of our listeners,
• 15:01
  hearing hearing from you right now, Jack. I
• 15:03
  also you know, to your point, three and
• 15:05
  a half percent seems to be the worst
• 15:08
  number in terms of an enrollment drop, and
• 15:09
  it'll probably come down from there, which really
• 15:12
  goes in the face of a lot of
• 15:13
  some of the projections we were seeing of
• 15:15
  that it was, you know, doomsday for the
• 15:16
  ACA to your point. So I think that's
• 15:19
  also, you know, at least on our end,
• 15:20
  worth some follow-up coverage of
• 15:23
  where did these projections go wrong.
• 15:25
  That's a that's another story.
• 15:27
  But like like you've mentioned, it it's early
• 15:30
  days still for ICRA, and it's only been
• 15:32
  around for six years now.
• 15:34
  That all being said, adoption has grown a
• 15:36
  thousand percent since 2020 around the country.
• 15:39
  I I know the data can be difficult
• 15:42
  to to collect. Small denominators
• 15:44
  for that growth, but, yeah, it's, it's it's
• 15:47
  picking up. And and the the highest end
• 15:50
  I've seen in terms of, enrollment is is,
• 15:53
  upwards towards a million people enrolled
• 15:56
  around the country in these types of arrangements.
• 15:58
  And that's on the upper end of projections.
• 16:00
  It it, you know, it I've seen in
• 16:02
  half, in terms of on the lower end.
• 16:04
  But I think overall,
• 16:05
  what do you think it's gonna take at
• 16:08
  this point moving forward to to move this
• 16:10
  from a niche product to to really a
• 16:12
  mainstream option that ensures the traditional insurers are
• 16:16
  are all in on?
• 16:17
  Good question.
• 16:18
  Yeah. I think, you know, the projections and
• 16:20
  data are are hard to get here. It's
• 16:22
  it's getting better. There's some, entities like the
• 16:25
  HRA Council.
• 16:27
  Kaiser Family Foundation put it on their survey
• 16:29
  this year, so we'll start to get a
• 16:31
  lot more data.
• 16:33
  I I think it's probably in the 400,000
• 16:35
  to 600,000,
• 16:37
  enrolled range. So it's very small in terms
• 16:41
  of the overall market.
• 16:43
  You know, but when you look at the
• 16:44
  ACA, it was at 24,000,000.
• 16:47
  Now it's gonna be, let's say, it shakes
• 16:49
  out at 20 to 21,000,000.
• 16:51
  You know, what's gonna grow it to 25,
• 16:54
  thirty, fifty million is is going going to
• 16:57
  be ICRA.
• 16:59
  And I think what is gonna,
• 17:01
  you know, move that forward,
• 17:03
  as the ACA shows more resiliency,
• 17:06
  as health plans get better,
• 17:09
  you start to see these positive snowball effects.
• 17:12
  And and one of the things I like
• 17:13
  to talk about is who is the ACA
• 17:15
  designed for, and then who is it working
• 17:17
  with for ICRA?
• 17:18
  So most of the policies, you know, rightly
• 17:20
  so, are designed for
• 17:22
  subsidized individuals that are are truly independent.
• 17:26
  So it's all about narrow networks and and
• 17:29
  thin formularies
• 17:30
  to try to get that low premium, $0
• 17:33
  premium plan and and show up at the
• 17:35
  top of the state marketplace.
• 17:37
  What's been fascinating with ICRA
• 17:39
  is it's attracting a new type of buyer
• 17:42
  to the individual market. These are medium and
• 17:44
  large employers
• 17:46
  employees at at employers.
• 17:49
  They want HSAs.
• 17:51
  They want,
• 17:52
  broader networks. They're less price sensitive. Like I
• 17:54
  said, they're not getting a tax credit or
• 17:56
  subsidy.
• 17:58
  And
• 17:59
  what's been interesting, Jacob, is starting to talk
• 18:01
  to some insurance carriers that are looking at
• 18:03
  this opportunity and saying,
• 18:06
  Hey. I can design an off exchange
• 18:08
  plan.
• 18:09
  Still ACA qualified. Right? But we're not gonna
• 18:12
  sell it through the exchange, which means we
• 18:13
  don't have to pay exchange fees. We don't
• 18:15
  have to do the silver loading thing, and
• 18:17
  we can design it, you know, with with,
• 18:20
  features that,
• 18:21
  these employees are interested in. And and I
• 18:24
  share that because I think it creates a
• 18:26
  positive snowball where, okay, if the ICRA market
• 18:30
  is at, you know, 400 to 600,000
• 18:32
  right now,
• 18:34
  and we see counties like Mongolia
• 18:36
  who are having to move to ICRA because
• 18:38
  of cost.
• 18:40
  Okay. Well, now there's more in the market.
• 18:42
  We see the ACA market stabilize.
• 18:45
  We see plans get introduced for this audience
• 18:48
  that attracts the next level of county, right,
• 18:51
  or the next employer that,
• 18:53
  says, well, hey. You know, we don't have
• 18:55
  to save as much. It's worth it, or
• 18:56
  these options are better or as good as.
• 18:59
  And I think you start to see that
• 19:00
  that positive snowball effect.
• 19:04
  One one ancillary we've studied closely, Jacob, is,
• 19:07
  the transition in corporate America from
• 19:10
  primarily pension plans,
• 19:12
  in the seventies and eighties
• 19:14
  to four zero one k style,
• 19:16
  plans
• 19:18
  in the late eighties and and in the
• 19:19
  into the nineties and and, of course, where
• 19:21
  we are today.
• 19:22
  And it wasn't a sudden
• 19:24
  shift. It wasn't like every year or one
• 19:26
  year, everyone moved, but it was very,
• 19:30
  steady and meticulous. And over a twenty year
• 19:32
  period, right, you
• 19:34
  see pension plans really start to fade,
• 19:37
  and you see four zero one k really
• 19:39
  start to to become,
• 19:41
  you know,
• 19:42
  early adopters and then mainstream, and then it
• 19:44
  becomes the primary vehicle for a lot of
• 19:46
  employers. I I think we'll see similar movement
• 19:49
  with ICRA.
• 19:50
  And that's a really good point, Jack. And
• 19:53
  and I think even if you were talking
• 19:54
  about,
• 19:55
  you just talk about pensions to four zero
• 19:56
  one k's. If we're talking about, you know,
• 19:58
  a comparable of traditional health insurance to ICRA,
• 20:01
  you know, that this is something that's been
• 20:03
  in place since you could say the forties.
• 20:05
  You know, it's gonna take time, to to
• 20:08
  un unroll this kind of system.
• 20:10
  And and something you'd said earlier in terms
• 20:12
  of the traditional insurers
• 20:14
  because we're we're hearing that too that it
• 20:15
  I think for a while we were hearing
• 20:17
  that they were worried it was gonna cannibalize
• 20:19
  some of their product lines. But now to
• 20:21
  your point, it's a lot of them are
• 20:22
  looking at this as as an opportunity,
• 20:25
  to pick up more business or or investing
• 20:27
  in some of these ICRA administration companies directly,
• 20:31
  is what we're what we're certainly seeing.
• 20:34
  Yeah. One one stat we love to throw
• 20:36
  out, and it's true. We've
• 20:38
  validated the HRA council and and with other
• 20:41
  ICRA administrators, but,
• 20:43
  85 to 90%
• 20:45
  of small employers
• 20:47
  under 50,
• 20:49
  are using ICRA to offer coverage for the
• 20:51
  first time.
• 20:52
  So we hear a lot of you know,
• 20:54
  there's concern about cannibalization.
• 20:56
  And, yes, in the in the upper market,
• 20:58
  you know, if you're a group carrier and,
• 21:01
  it gets busted up and it goes to
• 21:03
  ICRA, you you want an individual plan. They
• 21:05
  are ready to catch as many lives and
• 21:07
  members as you can.
• 21:09
  But on the small market, there is an
• 21:11
  enormous opportunity,
• 21:13
  to get new lives, new people covered,
• 21:16
  that have never had coverage before. So that's
• 21:19
  that's something that's been really exciting. Yeah. Definitely.
• 21:21
  Entirely untapped market. It's it's really interesting to
• 21:24
  think about. Well, Jack, you've got the ears
• 21:26
  of a lot of those
• 21:27
  traditional health plan leaders,
• 21:30
  from all over the country right now.
• 21:32
  So what else are we missing? Any final
• 21:34
  thoughts you wanna share with them, final bits
• 21:36
  of advice as we as we look into
• 21:38
  this new year?
• 21:40
  New year, you know, obviously, we're
• 21:43
  not not used to uncertainty,
• 21:45
  in in the space.
• 21:47
  But, I would really encourage,
• 21:49
  executives to to look at ICRA and think
• 21:52
  about the strategy there. And,
• 21:54
  it's picking up steam despite,
• 21:57
  you know,
• 21:58
  uncertainty in the ACA, and and, ultimately, I
• 22:00
  think it's gonna be a huge component and
• 22:03
  and proponent of the of the individual market.
• 22:06
  And we're starting to see more and more
• 22:08
  stories like this county in West Virginia,
• 22:11
  have a huge success,
• 22:13
  in moving
• 22:15
  moving to the to ICR arrangement.
• 22:17
  Now the county is happy and employees are
• 22:19
  happy. So that's that's something that I think
• 22:22
  you know, and it's it's not just cost
• 22:24
  arbitrage or or something like that.
• 22:26
  It's it it really is.
• 22:28
  Hey. There's there's a way that this can
• 22:30
  be a better model.
• 22:32
  So I I would encourage,
• 22:34
  executives to think about this, you know, reach
• 22:36
  out, to us at at Take Command.
• 22:39
  We have a whole,
• 22:40
  strategy primer on on ICRA. We're happy to
• 22:43
  share, and can look at trends in your
• 22:46
  local market.
• 22:47
  There's resources from the HRA council,
• 22:50
  and others as well. And and,
• 22:53
  you know, it's it's very small now, but
• 22:55
  but I think we're gonna see,
• 22:57
  steady and and significant growth. And and and
• 22:59
  I truly,
• 23:01
  to be a little bit provocative,
• 23:03
  I don't know if it's three years, five
• 23:05
  years, ten years, but but we will look
• 23:08
  back
• 23:08
  and say, oh my gosh. What happened to
• 23:10
  group insurance? It's all gone away or it's
• 23:13
  all changed over. And that sounds crazy.
• 23:15
  But, again, if I was talking to a
• 23:17
  pension exec,
• 23:18
  in the mid eighties, they would have said,
• 23:20
  oh, no way.
• 23:21
  But but look where they are now. And
• 23:24
  we're seeing the pull through demand from employers,
• 23:26
  and I think that's what's gonna really start
• 23:28
  getting,
• 23:30
  the attention of,
• 23:31
  health plan executives,
• 23:33
  brokers,
• 23:34
  and consultants.
• 23:35
  You know, employers look at this and say,
• 23:38
  heck, yeah. Why why wouldn't I do this?
• 23:40
  And, that should be either a red flag
• 23:43
  or a giant
• 23:44
  beacon of opportunity if if you're a health
• 23:46
  plan executive.
• 23:48
  It's fun to think about exciting stuff on
• 23:50
  the horizon for the industry. So, Jack, I
• 23:52
  I wanna thank you for taking the time
• 23:53
  to chat with us about what you're seeing
• 23:56
  recently across the country and for sharing your
• 23:58
  insights with our listeners. We really appreciate it.
• 24:00
  Absolutely. Hey. Thank you, Jacob, and and,
• 24:03
  thank you for having us on. Real pleasure
• 24:05
  and real honor. Absolutely. And to our listeners,
• 24:07
  if you'd like to listen to more podcasts
• 24:09
  from Becker's Healthcare, you can visit beckershospitalreview.com.