“In recent years, employer-sponsored health insurance has become less adequate in providing financial protection for all kinds of health care services,” says Avni Gupta, a PhD student in the department of public health policy and management at the New York University School of Global Public Health and the lead author of the analysis in JAMA.
The majority of working-age adults in the United States (61% as of 2019) obtain health insurance coverage through their employers. Despite improvements in employer-sponsored insurance by the Affordable Care Act—including extending parents’ coverage to uninsured young adults, eliminating copays and deductibles for preventive services, and implementing maternal care coverage—health care costs and out-of-pocket expenses have continued to rise.
Using the National Health Interview Survey, a nationally representative annual survey conducted by the Centers for Disease Control and Prevention, the researchers analyzed data from 2000 to 2020 for more than 238,000 adults aged 19 to 64 years who obtained their health care coverage through an employer or union.
Women with employer-sponsored insurance found all types of health care services to be less affordable than men. On average, 3.9% of women and 2.7% of men reported that medical care was unaffordable, 8.1% of women and 5.4% of men said dental care was unaffordable, 5.2% of women and 2.7% of men said prescription medications were unaffordable, and 2.1% of women and 0.8% of men reported that mental health care was unaffordable.
“Lower incomes and higher health care needs among women could be driving these differences in reported affordability,” says Gupta. “Employer-sponsored insurance plans need to redesign their benefit packages to reduce sex-based disparities.”
Over the two decades studied, both women and men found nearly all health care services to be less affordable in recent years compared to the early 2000s (although affordability for some services improved in certain years). For instance, approximately 6% of women found medical care unaffordable in 2020 compared to 3% in 2000, and roughly 3% of men said medical care was unaffordable in 2020 compared to 2% 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,” says José A. Pagán, professor and chair of the department of public health policy and management and coauthor of the paper.
Mental health and dental services showed particularly troubling trends in affordability. Women’s inability to afford mental health care sharply increased in the last few years included in the study—tripling from around 2% to more than 6%—while both men’s and women’s inability to afford dental services persistently remained the highest of all services every year from 2000 through 2020.
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