Cathy Grason Highlights How CHOICE Arrangements Can Bring Expanded Coverage to Maryland Small Businesses

Grason urged Maryland policymakers to consider greater education, marketplace support and a study of CHOICE as an emerging health benefits model.

October 5, 2026 — Maryland: Cathy Grason, vice president and associate general counsel, head of government affairs at Oscar Health, joined the Maryland Insurance Administration (MIA) and Maryland Health Benefit Exchange (MHBE) Oct. 1 joint meeting to discuss assistance for small businesses, highlighting how CHOICE arrangements could give Maryland employers another option to offer affordable, individualized health coverage to their workers.

Speaking as a member of the Insurance Choice & Affordability Alliance (ICAA), Grason described CHOICE arrangements, formerly known as individual coverage health reimbursement arrangements (ICHRAs), and Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs) as employer-funded models that allow businesses to make a defined, tax-advantaged contribution toward employees' individual health insurance rather than selecting a single group plan for their workforce.

For Maryland, Grason said the model's greatest value is for small employers that offer no coverage today. Nationally, more than two-thirds of small employers offering CHOICE arrangements and QSEHRAs had never offered coverage before, she said.

"This is not a silver bullet,” Cathy Grason told the panel. "Choice arrangements ... are not going to be the best option for every group. But it is absolutely an important option in the toolkit that unfortunately a lot of small employers don't know about."

Under a CHOICE arrangement, employers determine how much they can sustainably contribute toward health benefits while employees select an Affordable Care Act (ACA)-compliant individual market plan that fits their own needs. Those plans retain ACA protections, including guaranteed issue and essential health benefits, while giving workers greater flexibility than a traditional model in which an employer selects one or two plans for an entire workforce.

Grason emphasized that education will be essential, particularly around premium tax credit eligibility and the differences between CHOICE arrangements and QSEHRAs, and pointed to the role of brokers in helping employers understand those nuances. She noted that more than 60 administrators now offer decision support tools to help employers and employees with plan selection.

The model is also attracting bipartisan interest across the country. ICAA tracks CHOICE activity in 13 states. Grason described three approaches states are taking: tax credits designed to encourage employer awareness and adoption, exchange-based support for CHOICE arrangements, and independent studies examining their potential cost savings. ICAA endorses all three, she said, and offered to serve as a resource to Maryland as it evaluates solutions for small businesses.

Grason said 55% of small businesses that offer no coverage today are unaware of the option, calling the awareness gap what "keeps me up at night." She said affordability pressures are driving interest in the model.

"We do not believe that this is a perfect solution for every small employer, but we absolutely believe it is for some," Grason said.