More People With Employer-Sponsored Insurance Can’t Afford Health Care

A new study reveals that U.S. adults with employer-sponsored insurance increasingly struggle to pay for health care services.

Over the last two decades, health care has become less affordable for people with employer-sponsored insurance, especially for women, according to a study published in the Journal of the American Medical Association.

As of 2019, the majority (61%) of working-age adults in the U.S. obtained health insurance coverage through their employers. Despite the efforts to improve insurance through the Affordable Care Act (ACA), health care costs and out-of-pocket expenditures have continued to rise.

Using the National Health Interview Survey, researchers analyzed data from 2000 to 2020 for more than 238,000 adults aged 19 to 64 years with insurance obtained through an employer or union.

The study reveals that, on average, 3.9% of women and 2.7% of men reported not being able to afford medical care.

Dental care was unaffordable for 8.1% of women and 5.4% of men, while 5.2% of women and 2.7% of men said they could not afford prescription medication. Mental health care was unaffordable for 2.1% of women and 0.8% of men.

“Lower incomes and higher health care needs among women could be driving these differences in reported affordability. Employer-sponsored insurance plans need to redesign their benefit packages to reduce sex-based disparities,” Avni Gupta, a PhD student in the Department of Public Health Policy and Management at NYU School of Global Public Health and the lead author of the JAMA analysis.

According to the survey, both men and women found health care increasingly unaffordable over the years. In 2020, 6% of women and 3% of men reported being unable to afford health care, compared to 3% and 2%, respectively, in 2000.

“People with health insurance coverage provided by employers generally think they are protected, but our findings show that health-related benefits have been eroding over time,” said José A. Pagán, professor and chair of the Department of Public Health Policy and Management at the NYU School of Global Public Health and the co-author of the JAMA analysis.

A 2022 survey from the Kaiser Family Foundation (KFF) found that about half of the U.S. adults (47%) said that it was very or somewhat difficult for them to afford their health care costs. For minorities, affording health care is even more difficult, with 60% of Black adults and 65% of Hispanic adults struggling with costs compared to about 39% of White adults.

A 2021 study from the Commonwealth Fund found that among 11 high-income countries examined, Americans of all incomes have the hardest time affording the health care they need.

“What this report tells us is that our health care system is not working for Americans, particularly those with lower incomes, who are at a severe disadvantage compared to citizens of other countries. And they are paying the price with their health and their lives,” said David Blumenthal, M.D., Commonwealth Fund president.


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