Health Disparities in Employer-Sponsored Insurance
There is little nationally representative work examining health equity and health disparities within the employer-sponsored insurance market
Employer-sponsored health insurance (ESI) is the largest source of health insurance coverage in the United States, serving almost 155 million non-elderly people, or approximately 50 percent of the entire U.S. population. Despite the breadth of the market, there is little research on issues related to health equity and health disparities. Rather, most research on enrollee and purchaser experiences within the ESI market focuses on affordability and access, creating a knowledge gap.
NORC conducted a first-of-its kind analysis combining three nationally-representative surveys and vital statistics records to address this important knowledge gap
Morgan Health, a JPMorgan Chase business unit focused on improving employer-sponsored health care, commissioned NORC at the University of Chicago to study the issue. The analysis examines access to care and engagement in preventive health behaviors, health outcomes associated with chronic conditions, maternal health, substance use and behavioral health conditions, and food insecurity. The analysis includes descriptive statistics, age, race and ethnicity, and income-adjusted data. The study analyzed three nationally representative public surveys—the 2019 National Health Interview Survey (NHIS), the 2017-March 2020 National Health and Nutrition Examination Survey (NHANES), and the 2019 National Survey of Drug Use and Health (NSDUH)—along with birth certificates recorded in the 2020 natality vital statistics registry. The NHIS explores the health and social factors of the U.S. population, while the NHANES focuses on the health and nutrition of the U.S. population. The NSDUH examines alcohol and substance use and their associations with mental health. In each data source, NORC limited the samples to the adult population ages 25 to 64 years who reported having private health insurance through a job or employer. This methodology yielded sample sizes of 12,372 from NHIS, 3,103 from NHANES, and 14,580 from NSDUH. Data from these sources provide nationally representative information with relatively low uncertainty due to the large sample sizes at the national level.
The analysis provides a comprehensive look at disparities in the ESI market prior to the onset of COVID and reveals important insights about the state of health care and health outcomes among enrollees in the largest source of health insurance in the U.S.
NORC’s analysis found significant health disparities among ESI enrollees. Health disparities in chronic conditions, maternal health, behavioral health and substance use disorder are prominent among and between enrollee subgroups. For example, after adjusting for age and sex, Black enrollees were 16.7 percentage points more likely to have high blood pressure than white enrollees. Similarly, the percent of Lesbian, Gay or Bisexual enrollees were who reported serious psychological distress was 12.1 percentage points higher than straight enrollees.
Affordability was found as a challenge for many ESI enrollees, particularly those with low or moderate incomes, resulting in many enrollees avoiding or delaying needed medical care services or prescriptions due to cost. Lastly, a job and employer-sponsored insurance do not make enrollees immune to unmet social needs, with nearly 8 percent of ESI enrollees are food insecure. These findings highlight important focus areas for employers to develop programs and interventions to reduce disparities.