American workers are paying more than ever for health coverage they never chose, and many are afraid to use it. They hold the plan, they pay into it every month, and at the moment they need care they hesitate, unsure what it will run them or whether they can cover the bill. SureCo, one of the nation’s largest administrators of Individual Coverage Health Reimbursement Arrangements (ICHRA), argues that the distance between what workers pay and what they dare to use is the real crisis in employer health benefits, and today named Federico Salvitti as Chief Growth Officer to close it.

The numbers describe a workforce insured on paper and stranded in practice. Thirty nine percent of employees say they have delayed care because they could not afford it. Fifty three percent say they have struggled to pay a medical bill while insured. Yet ninety percent, often the very same people, still call their benefits satisfactory, because no one before now could show them and their employer what a fairer deal looks like.

“Nine in ten workers tell us they’re satisfied with their benefits. Four in ten also tell us they’ve skipped care they needed because of the cost. Both are true at once, and the space between them is the most expensive misunderstanding in American health care,” said Matthew Kim, CEO of SureCo. “The answer was never to make the same blind system a little cheaper. It was to hand people something they can actually see and choose. We brought Federico in to help us make that happen.”

An ICHRA changes who does the choosing. Instead of a handful of plans selected for the whole company, each employee receives a tax-free allowance from their employer and picks their own coverage, comparing plans that align to their lifestyle, at the price point and on the coverage they actually need.

Employers and their brokers are caught in the same trap. Employers watch premiums climb year after year with little new to offer their people, and brokers are left solutioning from a narrowing menu. The shift now underway is being led by the sharpest among them, a visionary segment of brokers steering smart employers toward a modern alternative. SureCo’s annual State of ICHRA report, its yearly study of broker and employer adoption, shows the movement building: a majority of brokers (56%) now recommend or implement the model, and the share who have moved at least one client onto an ICHRA has more than doubled since 2024, from 15% to 37%. Across the industry, roughly one million people are now enrolled.

“Benefits experts can explain how an ICHRA works, and they do it well. That was never the constraint,” said Salvitti. “The constraint is that most people have never been allowed to shop for their own health coverage, so they don’t know it is even possible. The day both employers and employees can see the prices and choose both contributions and plans is the day the power moves to those who pay. And once buyers have power, price starts to follow. My job is to get us to that day faster.”

Across three consecutive years, more than 91% of employers who adopted an ICHRA called it the right decision, and brokers reported average client savings holding near 15.5%.

“We helped build the model, we brought the carriers to the table, and we have measured the savings three years running,” said Matthew Christopherson, co-founder of SureCo. “The one thing nobody solved before now was the last mile, the moment a working parent finally understands they get to choose. That is the job we hired Federico to help us finish.”

Salvitti spent a decade in venture capital and private equity building growth strategies for companies that serve the insurance, banking, and payments sectors, with a focus on getting large, established organizations to change how they operate rather than simply understand that they should. His work has consistently joined three threads: the United Nations Global Compact and its Sustainable Development Goals, technology innovation, and applied AI. One example sits in Procter & Gamble’s annual report where Salvitti contributed to work P&G and EY brought to the supply chain sector. He founded and exited Europe’s largest University Portal, and teaches business management, marketing, and innovation at NYU. He is a speaker at Harvard, ANA events and other Business Management Associations.

Salvitti makes the same case at greater length on The Chris Voss Show, walking through what changes for employers and employees once coverage is something they can see, compare and choose: https://thechrisvossshow.com/the-chris-voss-show-podcast-revolutionizing-health-benefits-empowering-employee-choice-with-ichra/

About SureCo

SureCo is one of the largest administrators of large group ICHRA in the United States, with 13 years of tenure, the longest in the industry. Originally founded as an insurance brokerage, the company joined forces with the team that built the first group to individual coverage model and lobbied Congress to enable ICHRA in 2020. Today SureCo works with employers, consultants, and carriers nationwide, providing enrollment technology recognized with industry awards, direct carrier payments, compliance guidance, and employee education. Visit sureco.com.

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