By TJ Witham on Aug 5, 2026, 7:00:00 AM
The ICHRA Exclusive Podcast is back, and Open Enrollment is coming with it. The ACA marketplace won't look the same when it arrives. Employers are rethinking their options, the momentum behind ICHRA keeps building, and the first 2027 rates are already hitting employers' desks.
To make sense of it, we're joined by Chris Reuter, Chief Revenue Officer at Remodel Health and someone who has seen this market from the inside. After more than 20 years at UnitedHealthcare, most recently leading a national sales team of over 250 professionals, Chris knows exactly what's driving the shifts employers are feeling right now.
We get into what pulled him all in on ICHRA, the real story behind the recent carrier shifts, and why the affordability crisis may be the single biggest accelerant for ICHRA adoption yet. With several states already showing their hand, Chris makes his call on where 2027 rates are heading into Open Enrollment. He also names the one thing that has to change for ICHRA to reach its full potential.
If you're bracing for your 2027 renewal, watching the carrier landscape shift, or want a candid read on where ICHRA goes next, this one's for you.
Watch or listen to the ICHRA Exclusive podcast
Episode transcript
Chris Reuter: At a carrier level, carriers are approaching the market in a bifurcated way. We see a lot of single-digit rate increase carriers, and so when I look at the average, I look at what the main carriers are doing. The beauty of ICHRA is the ability to have choice and be able to change your benchmark plan. We're seeing a lot of key markets where the rate increases are lower than the state averages.
TJ Witham: Today, we're joined by Chris Reuter, Chief Revenue Officer at Remodel Health. With over 20 years of experience at UnitedHealthcare, where he most recently led a national sales team of more than 250 staff members, Chris brings deep expertise in sales strategy and carrier partnerships to Remodel's next phase of growth. Today, he's sharing his perspective on the shifts reshaping the ACA marketplace, the current affordability crisis in the United States, and where he sees rates headed in the year ahead.
You and I work together daily, hourly even, as our Chief Revenue Officer and the leader of the team I'm a part of. So it's a treat to sit down with you. At this point, I view you as a friend, and honestly, I'm super excited. Your experience and expertise make this the perfect time of year to have you on, because we're starting to see what 2027 rates are going to look like. I love the phrase you use: we're starting to read the tea leaves a bit. Really excited to have you share your expertise with our audience.
For those who don't know you, I'd love to start with your background. You came from UnitedHealthcare after a long, very successful career. Tell us about your background, and then I'd love to hear what got you over the fence to take the jump and move to Remodel Health and the ICHRA landscape.
Chris Reuter: I started in healthcare in 2005. I interviewed and accepted an entry-level position at UnitedHealthcare for a company called Golden Rule Insurance, which had recently been acquired by UnitedHealthcare to run the individual market. This predates Obamacare. We sold core medical plans in the individual market to consumers, and it was an incredible run.
Over that 20-year period, I had six roles, so I got to see different parts of the business. The last nine years I was Senior Vice President of Sales for their individual arm. I helped start their ACA division, and I was part of that with Marcus Robinson way back in the day. For those last nine years, I ran a call center of 250 people on the direct side, and we managed 60,000 brokers with our team.
Then we started acquiring businesses. I was part of the M&A team, and we acquired HealthMarkets, US Health Group, First Family, and Golden Outlook. UnitedHealthcare invested over a billion dollars into that space, and I was running some of those companies for them toward the end. It was an amazing run, and we grew that business substantially. By the end, I had 2.5 million people subscribed through our products at a company called UnitedHealthOne.
What brought me to Remodel was the two co-founders. When I started in 2005, one of my early bosses was a guy named Scott Lingle, and I quickly moved into management and managed somebody named Justin Clements. They were the two co-founders of Remodel, before it was ICHRA. They built Remodel Health, and over a 10- to 15-year period they tried to get me to come. They played the long game.
I had so much fun at UnitedHealthcare, but the pivotal point for me was becoming a member of the ICHRA panel at UnitedHealthcare. I got more visibility into ICHRA and the thinking and strategy around it, and I became a believer that this was going to be a macro shift in the industry over time. I play long games. I look in 10-year time horizons, and I saw that this was going to be a really exciting space for many years to come, driven by the macro trends. So in April of 2025, I told Scott and Justin I would come. They needed somebody; the chief growth officer before me was a guy named Brian Young, and I was really excited to join the team. It's been a dream ever since.
TJ Witham: I love that, and it's a blessing to work with you. On a personal level, when we were planning this episode, we said that at this time of year, all of our broker partners and CFOs for employers start to get anxious. They wonder what the trends for next year are going to look like, and we thought there's no one better to speak to the macro picture around the ACA. So I'm super excited to have you.
First question: what's your perspective on the recent carrier exits? We've had some big news this year that certain carriers are getting out of the ACA entirely, like Cigna, plus other state-by-state news of carriers pulling out, including more regional carriers. What's your perspective on that news and on the shifts in the ACA in general as we look forward to 2027?
Chris Reuter: In the macro environment, there are eight carrier exits so far in the market. Some are national, like Cigna, but mostly state and local markets. What's really interesting is the market share of those eight carriers. The ACA pool is about 19.2 million by the latest estimates, and there are about 700,000 enrollments from those eight carriers, which represents 3.6% of the overall market.
What we're seeing is that the carriers that are fully vested, those that can typically manage risk effectively, because risk adjustment is such a critical part of the ACA market, and that have good, strong national networks, are doubling down. There are a few carriers where it's just not their core business.
TJ Witham: Cigna is one. In my opinion, and sorry, I'm interjecting a bit here, Cigna is an ASO self-funded juggernaut.
Chris Reuter: That's right. If you look at where their membership is across all of Cigna's book, ACA was a tiny little drop.
TJ Witham: Because they're such a well-known brand with group carriers and big employers, the news almost carried more weight than it really should have when you looked at the numbers.
Chris Reuter: Yeah. It's 3.6% of the market impacted. The carriers that own the dominant share, Ambetter, Oscar, Elevance, a lot of the Blues, UnitedHealthcare, have doubled down, especially in the off-exchange market, and they represent roughly 60% of the market. So those that are staying in are doubling down. Those on the tertiary and the sidelines are asking whether this is a core, tactical part of their business, and some, like Cigna, are saying this just isn't who we are, and we don't want to compete.
TJ Witham: Makes total sense. Around the time this airs, you've also written a great thought leadership piece on the five trends you see in the future for ICHRA. One interesting stat I'd love you to share is the number of off-exchange plans now available compared to a couple of years ago, versus the number of on-exchange plans available. I won't hold you to specific numbers, but talk to our audience about that.
Chris Reuter: One of the things that's so incredible about ICHRA is the choice. As you roll up the national data, it's fascinating. I don't know if listeners know this, but between the on-exchange and off-exchange markets in 2026, there are about 20,000 plan offerings in the individual market. It varies state by state, but it all rolls up into that 20,000.
When I started, and I predate ACA, so I'm rather old, off-exchange used to be an afterthought. I was around when the ACA kicked off in 2014, and I've been through every iteration of it, so I'm an individual market expert. What we're seeing is that the off-exchange market in 2026 grew to 9,000 plans. So 40% of the plan offerings are now in the off-exchange market, and the fastest-growing segment is off-exchange. That's grown 36%, and that's really where the beauty of ICHRA lies, because of the tax benefits.
TJ Witham: 100%. I'd add the off-exchange plan flexibility that carriers are investing in, and how they're being creative to manage risk of that off-exchange-specific block. We're seeing ACA carriers invest in direct primary care relationships that are only available with those off-exchange plans, because they know it's something ICHRA members want. If members are coming off a group health plan where the employer offered a near-site clinic or direct primary care, carriers know members sometimes want to keep that. So they're investing in off-exchange-specific plans that include direct primary care, for example. It's really cool to see the number of off-exchange plans increase, and also the creativity of what's included in them.
Chris Reuter: I think what you're going to see is that carriers used to rely on the subsidy market to drive all their growth. As the subsidy expansion was rolled back in the on-exchange market, carriers now view the growth as off-exchange, in the ICHRA space. So we see their creativity doubling and tripling down there. I talk to carriers every week. I've seen what they're doing, and I've asked for permission to share. They're going to come out with announcements soon that I think will make people say, wow, there are some really interesting, innovative plan designs happening in the off exchange space.
TJ Witham: One of the other big things you talk about is that, at a macro level, the US is facing an affordability crisis right now. I don't think there's any doubt about that. How do you see the broader affordability crisis impacting the ICHRA option in the next few years?
Chris Reuter: There's affordability at a broad scale. There's a Guardian poll that said 95% of Americans think there's an affordability crisis in America as it relates to healthcare. KFF did an amazing survey that said it's the number one concern, even over gas. Honestly, they're neck and neck; gas, groceries, and healthcare are the top things on people's minds.
That's driven by a couple of things. We spend over $5 trillion a year, or 18% of our GDP, on healthcare. That breaks down to over $15,000 per person in the healthcare system, so it's incredibly expensive. Medical debt is the number one reason people declare bankruptcy. So we have a huge crisis in America on healthcare.
The great thing about ICHRA is that it's politically neutral. Almost everything in this country is split: red state, blue state, conservative, liberal. What I love about ICHRA is that both parties view it as part of the solution. It's not a silver bullet, but it's part of an overall ability to address the affordability crisis in America. So it's one factor that I think will be very important.
TJ Witham: It's actually something I get probably twice a week. As we're expanding, I'm out meeting with different brokers and broker leaders, and we start talking about which states are good for ICHRA. One of the number one veins people go down is, oh, ICHRA is going to be really good in red states and not blue, or vice versa. But if you ask me what states are good for ICHRA, my top ten is about five red states and five blue states, because it's pretty politically neutral. It's really more about where the individual markets are strong, which carriers have rich plans, strong networks, and good premium prices. It's less about politics.
Chris Reuter: Totally agree.
TJ Witham: I'd love to ask one sub-question around the affordability crisis. Where do you see ICHRA for larger cases in the next two, three, four years? Do you think we'll see more and more larger employers, in the multi-thousand or even tens of thousands, start to look at ICHRA, maybe not for their whole population but for subsections of it, to help solve the affordability concern?
Chris Reuter: What I'm really excited about, and we'll get into the specifics, is that the upstream market for ICHRA is really untapped. We see tremendous growth in our quotable pipeline in the number and size of employers. In fact, this month, in July, we just won one of our largest groups ever. So we continue to go upstream in that market.
But where I think the future is is the jumbo market. I think employers are going to get very creative about splicing populations and looking at them in a different way to ask whether ICHRA is best for a given population. We already see some interesting trends there. I think the big jumbo segment is going to be the last domino to fall, probably in the next 12 to 18 months, as that market becomes ripe for these conversations. The use case for splicing populations and thinking of ICHRA as part of a solution is an untapped market that you're going to see start to evolve.
TJ Witham: For our listeners who aren't familiar, Ambetter is the largest individual ACA carrier in the country, and its parent company is Centene. To your point, Centene actually moved all of their Indiana employees off their legacy self-funded plan to offering ICHRA at the start of January 1, 2026. We're super tight with them, and they're a huge carrier partner for us at Remodel. I'm close with a lot of their Indiana sales leadership, and their perception of ICHRA as an end consumer, because they had to go through and pick an individual plan, has been very positive. Sitting down at lunch with them over the last several months and hearing their personal experience has been insanely encouraging to me. I always love getting down to the end consumer and hearing their feedback on what it was like, and it's been very positive. So I think they're a leader in that segment, a jumbo with tens of thousands of employees moving a subsection of their population to ICHRA. It's been really cool to see, and they're just the first of many we'll see in the next several years.
Chris Reuter: Agree.
TJ Witham: Awesome. So we've started to read the tea leaves. At this stage, we're getting close to 50% of states, not quite, but close, that have released their SERFF rates for 2027. What are your predictions for rates in general as we head into Open Enrollment season?
Chris Reuter: Going into it, we have the early bird view. There was an article yesterday that said the national rate increase was 14%. We have internal data too, some weighted by the population of the carrier, some just state average trends. What I've told everybody here at Remodel is that everything is pointing to a 13 to 17% rate increase environment in the 2027 plan year, with a couple of really important caveats.
One is that each state is showing different trends. We see a lot of single-digit states that give us encouragement. The other thing is that, at a carrier level, carriers are approaching the market in a bifurcated way. We see a lot of single-digit rate increase carriers, so when I look at the average, I look at what the main carriers are doing. The beauty of ICHRA is the ability to have choice and change your benchmark plan. We're seeing a lot of key markets where the rate increases are lower than the state averages. But I expect it to be about 13 to 17%.
The article yesterday said 14%. California just came out with really encouraging numbers; our article uncovered that California was single digits. So I'm encouraged that it's moderating. The synopsis I'd give the audience is that rates are moderating from last year, and I expect next year to moderate from this year.
One of the key factors is the loss ratios. I study the earnings reports of all the key carriers, Oscar, Centene, Ambetter, Elevance, United, and a constant theme I'm seeing is that loss ratios are improving in the ACA market. That means rates are pegged to that, and we're going to see an improving rate environment over time.
TJ Witham: The other encouraging thing, and this is in your thought leadership piece that's going to be published, is that the off-exchange-specific risk pool is getting better while the on-exchange risk pool is getting slightly worse. The off-exchange pool has actually gotten better over the last couple of years. That was one of the objections a lot of brokers had in 2022 and 2023, as ICHRA started to accelerate. Some thought that employers moving to this would dump bad risk into the off-exchange risk pool. I always said it was a valid concern, but what's encouraging is that we're starting to have enough historical data year over year to see that the off-exchange risk pool in three of the four metal levels, bronze, silver, and platinum, has gotten better. Gold is slightly higher, but ever so slightly. Looking at it holistically, the off-exchange risk pool has gotten better while the on-exchange risk pool has gotten slightly worse. That's insanely encouraging, and it starts to debunk the objection that employers moving from traditional group health plans to ICHRA would pollute the off-exchange risk pool. It's just not what we've seen.
Chris Reuter: It's super encouraging, because that is a key thing carriers look at. With the subsidies going away, if you'd told me the on-exchange market risk pool would get worse, that was my base case, and it's proven true. That's what's driven a lot of the rate increases you're seeing in the on-exchange pools. As the subsidy expansion goes away, people who didn't need the subsidy, or who are healthy, aren't going to get insurance, so we've seen that market impacted by about 3 million people. The off-exchange getting better over time is a super encouraging trend, because it tells you there's an opportunity for off-exchange rates to improve, for trends to moderate, and for carrier investment to flow. We see carriers investing, and I think they're going to double and triple down over the next 12 to 24 months.
TJ Witham: A couple of other trends too: the average age of off-exchange enrollment is lower than on-exchange, and the persistency of individuals enrolling in off-exchange is higher than on-exchange. Two other good sub-metrics that point to the health of the off-exchange market long term.
Chris Reuter: Persistency is so underrated. If you keep a member with you for multiple years, you can manage their risk better. There are so many open doors for a carrier not to be able to lose money. If they don't feel like they're going to keep a member, they're not going to invest as much. So persistency is kind of the secret weapon that off-exchange and ICHRA provide.
TJ Witham: 100%. I've long thought that as ICHRA continues to grow and more employers offer it, the thing I get excited about is this. Take Remodel Health, and don't worry, Chris, I'm not looking at leaving my job anytime soon, but the Witham family is enrolled in an individual plan. I've got my wife and two sons. If I were to leave Remodel and go to another company in Indianapolis that offered an ICHRA, I'd stay with my exact same plan and carrier, and they'd have all the historical claims data for the Witham family. There's no loss of data and no loss of continuity of care, and from a health insurer's perspective, the ability to keep managing the risk and the overall health of the Witham family would have long-term gains if I moved to another ICHRA employer. I get really excited about that: as ICHRA grows, the persistency of even people who leave one employer for another that offers an ICHRA, who can stay on the exact same carrier and plan.
Chris Reuter: Huge advantage, for sure.
TJ Witham: Last question, and this is what we ask every guest. Dream for a minute: what is one thing you would change, or that would mature, in the ICHRA landscape in the next five years?
Chris Reuter: On a longer-term basis, what excites me more than anything are the two markets we see growing. We talked a little about the jumbo market. If I look into the future, I think ICHRA is going to exceed a million lives in the market by 2027. I think we're in inning two of a nine-inning game. As the jumbos get more involved and the splicing occurs, one of the things I'd like to see, when I look at the integrations and the on-exchange pathways, is legislation that would open up the on-exchange. There are 9,000 choices on the off exchange. If we could open up the other 11,000 on exchange and have the full weight of the individual market, I think that would be really beneficial to consumers.
I also think the deeper we can get with integrations, the better the change management. The technology is evolving, but the question is whether we can take on an 80,000-life group today. I want to make sure we're really dealing with the issues of the pipes and the friction in that pathway, to open up the true jumbo market. Looking three to five years out, I think it's going to be a really exciting time to be in the ICHRA space.
TJ Witham: I agree. Well, it's a blessing to have you on. I get to work with you every single day, and I knew you'd be great for our audience, sharing your thoughts on the future of ICHRA and what rates are looking like for 2027. I can't thank you enough.
Chris Reuter: Happy to be on. It's great to see you, TJ.
