More than 20,000 American businesses now give employees a fixed sum of money to buy their own health insurance instead of offering a group plan, and the health consequence for workers is not usually the loss of coverage. It is losing the network.
The figure comes from Volume 5 of the HRA Council's annual report, released on August 12, 2026. The trade association estimates that those businesses will offer an individual coverage health reimbursement arrangement, known as an ICHRA, or the small-employer version known as a QSEHRA, to at least 500,000 employees in 2026, and that ICHRA-covered lives alone passed 500,000 at the start of the year. The fastest-growing adopters are no longer small businesses. They are applicable to large employers, companies with 50 or more full-time equivalent employees, whose adoption more than doubled on average from the prior year.
