For decades, the dominant form of private health insurance in the United States\u2014by far\u2014has been employment-based group health insurance. Somewhere in the range of 175 million employees and their families receive health care coverage through a system in which employers serve as financiers, procurers, administrators, and fiduciaries of the health insurance promise. An overwhelming percentage of those health insurance arrangements are governed by ERISA, with little room for state law.<\/p>\n\n\n\n
That is going to change.<\/p>\n\n\n\n
This Article explains\u2014for the first time anywhere\u2014why and how. Because of the tremendous and as-yet unrecognized power of an obscure-sounding funding arrangement called the Individual Coverage Health Reimbursement Arrangement (ICHRA), a massive insurance transition\u2014away from ERISA-governed group insurance and toward individual insurance\u2014is likely to occur. It\u2019s already underway. The end result, whether sooner or later, will be a meaningfully transformed insurance landscape policymakers will not have the freedom to ignore. It will happen much like how retirement accounts replaced pensions in the retirement context.<\/p>\n\n\n\n
The second claim this Article makes is normative. The transition from pensions to retirement accounts made society worse off. Yet this benefit transition\u2014from ERISA insurance to individual insurance\u2014is one that could make society better off, if sensibly regulated. A reasonable transition to individual insurance will likely have salutary effects on the exchanges and their offerings; on employees; on employers; and on regulators.<\/p>\n\n\n\n