The Complete History of ICHRA: From Executive Order to Congressional Codification

Every policy has an origin story. For ICHRA, the story dates back decades. 

ICHRA: the Origin Story

ICHRAs first officially entered the scene in October 2017 when the Trump Administration issued Executive Order 13813, “Promoting Healthcare Choice and Competition Across the United States.”

On June 20, 2019, the “Final Rule” governing ICHRA was formally introduced into the Federal Register by the Internal Revenue Service, the Department of Labor (DOL), and the Department of Health and Human Services (HHS). The very first businesses started offering ICHRAs to their employees in January 2020.

Tracing ICHRA’s Roots Through U.S. Healthcare History

Although ICHRAs were officially created through a 2017 executive order, they are part of a century-long history of U.S. healthcare reform efforts. Here’s how the story has unfolded:

• 1912 – Teddy Roosevelt
  • Initiative: Progressive Party platform proposed national health insurance
  • Outcome: ❌ Not enacted
    ‍
• 1945–1949 – Harry Truman
  • Initiative: Proposed universal health insurance after WWII
  • Outcome: ❌ Not enacted
    ‍
• 1965 – Lyndon Johnson
  • Initiative: Signed Medicare and Medicaid into law, creating the first major federal coverage programs
  • Outcome: ✅ Enacted
    ‍
• 1974 – Richard Nixon
  • Initiative: Introduced the Comprehensive Health Insurance Plan with portable, employer-funded accounts
  • Outcome: ❌ Not enacted
    ‍
• 1993 – Bill Clinton
  • Initiative: Proposed the Health Security Act with an employer mandate
  • Outcome: ❌ Not enacted

• 2010 – Barack Obama
  • Initiative: Signed the Affordable Care Act (ACA), establishing marketplaces and subsidies
  • Outcome: ✅ Enacted

• 2017 – Donald Trump
  • Initiative: Issued Executive Order 13813, leading to ICHRA regulations finalized in 2019
  • Outcome: ✅ Enacted

In today’s political context, ICHRAs bridge the gap between political priorities. For Democrats, ICHRA builds directly on the Affordable Care Act by channeling more workers into the ACA marketplaces and expanding access to affordable, regulated coverage. For Republicans, it reflects free-market principles, introducing more competition among insurers and giving individuals more control over their health dollars. The result is a policy that strengthens the ACA ecosystem while advancing consumer choice—an unusual point of bipartisan convergence in the U.S. healthcare system.

The Mechanics

Today, ICHRA continues to be governed by “Rules.” This detail is actually pretty important in today’s political climate.

ICHRA operates in a regulatory limbo, which creates both opportunities and risks.

Unlike Medicare or Social Security, ICHRA isn't written into law. It exists through federal rules issued after Trump's 2017 executive order, which were implemented by the IRS, the Department of Labor, and HHS. This distinction matters more than most employers realize.

Rules are fragile. New administrations can rescind executive orders or install agency leadership that reinterprets existing regulations. The Biden Administration could have killed ICHRA entirely and chose not to, even while actively dismantling other Trump healthcare policies. That non-action speaks volumes about ICHRA's bipartisan appeal and market momentum.

But survival isn't the same as security. As long as ICHRA exists only through rules, it remains vulnerable to political whiplash. A hostile administration could strangle it through enforcement changes, guidance reversals, or regulatory delays without touching the underlying framework.

This is why codification matters.

The HRA Council (which Venteur actively supports) is pushing Congress to write ICHRA into the U.S. Code. Codification would require new legislation to undo, not just administrative preference. It would also establish structured oversight and predictable rulemaking, providing employers and carriers with the regulatory certainty they need for long-term planning.

For employers considering ICHRA today, the regulatory foundation is solid but not permanent. The market has spoken: the tens of thousands of businesses that have adopted ICHRA prove that demand exists. Now it's time for Congress to catch up and provide the legislative backbone this transformation deserves.

Recent attempts to codify ICHRA include: 

• HR 3799, “Custom Health Option and Individual Care Expense (CHOICE) Arrangement Act.”
• HR 1, “One Big Beautiful Bill” 

New Momentum in Congress?

Last week, three new ICHRA bills were introduced in Congress, each taking a different approach to strengthening the foundation of ICHRA. H.R. 5463 and its Senate companion, S. 2875, both amend the Internal Revenue Code and make ICHRAs a permanent fixture of the law.

A third bill, H.R. 5498, directs the Small Business Administration to provide education and guidance to small businesses on how to use ICHRAs

Taken together, these proposals suggest that codification—and therefore long-term 

What’s Next? 

With three new ICHRA bills now active in Congress, the focus shifts from regulatory survival to legislative permanence. The coming months will determine whether these proposals gain traction in committee and garner the bipartisan support necessary to move forward. For employers, carriers, and brokers, this means two things. First, the current framework remains stable and operational. Second, the long-term future of ICHRA is being shaped on Capitol Hill now. If codification advances, it will give businesses the confidence to make multi-year benefit strategies around ICHRA, knowing the rules will not change with every administration.