Employers swamped by rising health costs have found an alternative to traditional workplace coverage: giving workers cash to buy a plan themselves.

Why it matters: The approach is being touted by the Trump administration and JPMorgan Chase executives, among others, but is largely dependent on the market for individual coverage — which is currently facing double-digit premium increases.

The big picture: The option, known as Individual Coverage Health Reimbursement Arrangements (ICHRAs), emerged during the first Trump administration. They've since been rechristened CHOICE arrangements.

• Workers can use the tax-free contributions to buy individual coverage either on or off Affordable Care Act exchanges or through Medicare.
• Employers have an advantage setting the contribution level and ensuring more predictable costs, while employees, in theory, can use the money on coverage that's best suited for them.
• But companies wary about the health of the individual market have been slow to dive in.

Driving the news: In a new policy paper provided first to Axios, Morgan Health CEO Dan Mendelson and JPMC Business Banking CEO Stevie Baron call on federal and state policymakers to promote small business participation through policy changes.

• Citing heavy premium increases and large deductibles within the small group insurance market, they call for Congress to enshrine CHOICE arrangements into law, and for state legislators to consider giving employers tax credits and to strengthen state-based reinsurance programs.
• They also point to self-funded association health plans, multiple employer welfare arrangements and other options small businesses can use to offer some form of affordable coverage.

Just last month, the Trump administration promoted ICHRAs and gave them a new name.

• "CHOICE arrangements let workers choose coverage that meets their unique health care needs, which can often offer better options than traditional employer plans," CMS administrator Mehmet Oz said at the time.

Zoom out: Though rising employer costs have shaken the benefits world, the small group market is especially struggling.

• Insurers offering small group coverage reported a median proposed premium increase of 14% for next year, according to KFF.
• "The interest in the CHOICE model really stems from the crushing rise in costs that small businesses face," Mendelson said in an interview.
• "We see that market imploding and that's why we're jumping in."

Yes, but: Enthusiasm for the program stands in contrast to warnings of high premium increases and potential instability in some ACA marketplaces following January's expiration of enhanced subsidies.

• ACA plans are unattractive to workers, undermining the success of the CHOICE program, said Brian Blase, president of the Paragon Health Institute. Blase helped create the program during the first Trump administration.
• "I am very bullish on defined contribution health insurance as a concept and I think we need to get there," he added.
• "I just think we're six years in, and they're not performing anywhere near where I expected they would, and I think to expect them to get better without significant policy changes and changing the rules ... it's probably not going to happen."

Where it stands: At least 500,000 employees now buy coverage through a CHOICE program, and use is growing, according to the HRA Council.

• The median employer allowance through defined contribution programs (either through the CHOICE program or older qualified health reimbursement arrangements) covered 81% of the median premium in 2026.
• But while a third of employers surveyed by the Employee Benefit Research Institute and Morgan Health said they're planning or evaluating a CHOICE arrangement, only 11% said they're actively planning implementation.
• Concern over premiums and out-of-pocket costs and the quality of such plans was cited as a top barrier to adoption.

The bottom line: "The growth would be faster if there were better products on the exchanges and if the exchanges were more stable," Mendelson said.

• "This should be a bipartisan issue where members could come together and say we want this to be an option for employees."

The drug industry employed almost 1.08 million people in the U.S. in 2024, with growth in R&D offsetting job losses due to mergers and productivity improvements, according to a new report provided first to Axios.

Why it matters: The tally, based on the most recent complete Bureau of Labor Statistics figures, reflects the period before major drugmakers agreed to reshore certain operations and build new manufacturing as part of "most favored nation" deals with the Trump administration.

• It found biopharma jobs grew 19.5% from 2020 to 2024, or more than three times the rate for all U.S. manufacturing.
• Drugmakers had more R&D workers than the semiconductor, automotive and aerospace industries.

By the numbers: Seven states — California, Massachusetts, New Jersey, New York, Pennsylvania, North Carolina and Texas — each had more than 50,000 drug industry workers, per the report from TEConomy Partners for the trade group PhRMA.

• Factoring in suppliers to the manufacturers, the industry supported more than 350,000 jobs in California, Massachusetts and New Jersey.
• The average biopharmaceutical job had a total compensation level of nearly $170,000 per year in 2024, or more than $60,000 above the average U.S. manufacturing job.

Between the lines: The industry frequently cites its economic reach when arguing against expanded drug price negotiations or changes to the patent system that it maintains could squelch innovation.

• Those and other changes could be on the table if Democrats flip one or both houses of Congress in the midterm elections.
• Big Pharma's business deals with Chinese life sciences companies also face new screening requirements and possible prohibitions.

Studies of long COVID have dramatically overestimated the range and duration of health effects linked to the virus, data scientists at Stanford University conclude in a new analysis based on insurance records from more than 244 million Americans.

The big picture: The findings don't mean long COVID is less common, but fundamentally change which health effects can be reliably blamed on being infected, the researchers write in Proceedings of the National Academy of Sciences.

• That's a cautionary tale for future large-scale population health studies that could be unintentionally biased.

Long COVID's lingering symptoms have mystified scientists and frustrated patient advocates. Patients have described "brain fog," fatigue, dizziness, shortness of breath and other symptoms affecting multiple organ systems that last a year or more after the infection passed.

What they found: Earlier studies compared people who tested positive for COVID-19 against people who were never diagnosed, including people who were not tested, the Stanford team noted.

• This created misleading connections, because those who got tested may have had underlying conditions, non-COVID infections, or just sought medical care more frequently.
• The researchers instead focused on patients who got their first molecular test and examined long-term outcomes for those who tested positive against those who tested negative.
• Doing so resulted in 98% fewer health outcomes attributable to long COVID between four and 12 months after infection, compared with conventional approaches.

The team identified muscle weakness, non-tuberculous lung infections, respiratory issues and collapsed lung among the top COVID-attributable effects.

Yes, but: Researchers acknowledged the insurance data they used was primarily designed for billing purposes and may be lacking in clinical accuracy.

• They also couldn't include people who took at-home COVID tests, unless they sought follow-up care.