Health Affairs October 1, 2025
The recently enacted budget reconciliation bill (formerly known as the One Big Beautiful Bill Act) included dozens of health policies—but excluded the House-passed codification and incentivization of individual choice health reimbursement arrangements (ICHRAs) as well as the extension of the expiring enhanced health insurance Marketplace premium tax credits from the American Rescue Plan and Inflation Reduction Act. While they are gone, they are not forgotten.
Here, we propose a way to connect premium tax credits with health reimbursement arrangements for small businesses that have long struggled to offer health benefits. It would blend the competing health tax proposals—tax-preferred accounts and credits—through changes to qualified small employer health reimbursement arrangements (QSEHRAs). Created in a 2016 law, QSEHRAs allow small employers to...
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