A Black man sitting on his couch and. holding onto his knee in pain.
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A report released in March 2024, The Hidden Lives of Workplace-Insured Americans, reveals the challenges facing people with employer-sponsored health insurance. Despite having access to health benefits, many Americans delay care, with significant consequences for their physical health as well as their social and psychological wellbeing.

Despite having a full-time job with health benefits, many study participants reported that they couldn’t afford the care they needed.

The report details a large-scale qualitative study conducted by Nonfiction Research, an independent research company, on behalf of Paytient, a technology firm. The study consisted of interviews with 1,156 Americans with employer-sponsored health insurance and ethnographic observation of the households affected by delayed care.

The study shows that “short of a healthcare revolution,” people insured through their workplace need greater protection from increasing healthcare costs and better coverage, or they will continue to struggle with compounding health issues, financial burdens, and negative impacts to their work and family lives.

Middle-Class Americans Are Delaying Care

Participants in the Nonfiction Research study had above-average incomes, with nearly a fifth earning over $100,000 in salary each year. Their income levels and corresponding access to resources may lead some to assume that this group can afford healthcare. However, despite having a full-time job with health benefits, many study participants reported that they couldn’t afford the care they needed.

According to Nonfiction Research, 45 percent of the people with worker-sponsored healthcare they spoke with could not pay their single coverage deductible in 2023. On average, they were $1,482 short of meeting the deductible.

“Both my parents died in their 40s from heart attacks. I had been having some chest pain and was ordered to have a stress test. I was told I would have to pay $250 up front. I still haven’t had the test.”

Approximately 40 percent of workplace-insured Americans who participated reported delaying care due to cost. Of those who delayed care, more than half (56 percent) delayed dental care. And nearly half (48 percent) did not seek care from a specialist or a referral. Participants also delayed other types of care at high rates: primary care (39 percent), vision (31 percent), mental health (26 percent), and reproductive care (14 percent).

Among those respondents who delayed care due to costs:

  • 32 percent put off regular doctor visits or check-ups
  • 30 percent didn’t go to follow-up visits
  • 27 percent didn’t get a medical test
  • 27 percent didn’t undergo medical imaging such as X-rays or mammograms
  • 27 percent didn’t act on a specialist referral
  • 24 percent didn’t get regular treatment for chronic conditions or recovery
  • 23 percent didn’t fill a prescription medication
  • 23 percent skipped emergency visits or urgent care visits
  • 20 percent didn’t get outpatient surgeries
  • 9 percent didn’t get inpatient surgeries
  • 5 percent never sought out needed medical devices

Some study participants reported delaying care despite having a family history of chronic disease. One study participant who delayed an important heart exam due to cost said, “Both my parents died in their 40s from heart attacks. I had been having some chest pain and was ordered to have a stress test. I was told I would have to pay $250 up front. I still haven’t had the test.”

Delayed Care Is Corroding American’s Health  

Delaying care—including not taking the medicine prescribed by a doctor or declining to see a doctor at the first sign of an illness—can exacerbate health issues. Accordingly, of the 40 percent who shared that they have delayed healthcare due to costs, 38 percent said their health worsened as a result.

Even people with serious health conditions delayed care due to the exorbitant cost of treatments. As a study participant commented, “I have multiple sclerosis and I have had to put off doctor appointments, MRIs, and medications quite a few times due to not being able to afford the co-pays. This has caused my disease to get worse at times which meant I could not go to work, and I would just lay in bed for days due to not being well.”

Delayed care can lead to emergency room (ER) visits, which are also costly. One study participant commented, “I left work one day because my blood sugar was too high, I couldn’t afford my insulin, and then I ended up in the emergency room overnight.” In addition to ER visits, delaying care may also complicate a medical issue, leading patients to need surgery or other serious healthcare treatments when the issue is finally addressed.

Whether it’s an ER stay, surgery, or some other medical procedure, delaying care can raise healthcare costs. According to the study, 17 percent of those who delayed care eventually received more expensive treatment for the same issue.

The price of prescription medication can lead people to engage in inadvisable behaviors regarding medicine consumption, such as hoarding or rationing. This showed up in the Nonfiction study when a participant’s efforts to make their medicine last longer backfired: “Last year I cut my arthritis medication in half and only took half a dose every day because I was trying to save enough for the end of the year…But when I went to the doctor, he told me it’s a time release med, so if I cut it in half it doesn’t work.”

“I left work one day because my blood sugar was too high, I couldn’t afford my insulin, and then I ended up in the emergency room overnight.”

More concerningly, the study found that patients delayed crucial medical treatment, even when their lives could be on the line. Of the 40 percent who delayed care, 7 percent also delayed a major procedure or surgery for potentially fatal conditions or injuries. A 55-year-old study participant who was making around $95,000 a year (substantially higher than the national average salary of $61,900 according to the US Bureau of Labor Statistics) said, “My doctor found a nodule on my thyroid, and I delayed the test to look for other options and then I found it was cancer.”

Delayed Care Intensifies Stressors and Other Socioeconomic Issues

Approximately 34 percent of interview participants who said they delayed care due to financial burdens told Nonfiction Research that it negatively affected their mental health. This showed up in different areas of study participants’ lives:

  • 24 percent said they couldn’t sleep through the night
  • 17 percent said they couldn’t exercise
  • 14 percent couldn’t eat the foods they loved
  • 14 percent smiled less
  • 11 percent had to temporarily stop or completely give up a hobby
  • 7 percent missed a major family or life moment
  • 6 percent avoided sexual activity

A 36-year-old mother who delayed physical therapy told Nonfiction Research, “I can’t 100% be the mom I want to be. Sometimes when my daughter is crying, I just want to pick her up and carry her. I would love to just grab her and walk with her to make her feel better. But I can’t because I’m in too much pain.” Researchers invited into her home as part of the ethnographic portion of the study observed her using an extender to pick up her five-year-old daughter’s toys because she couldn’t pick them up as she had before.

Delaying care also affected participants’ work and employment decisions. Nearly 17 percent, or one of every six people who participated in the Nonfiction study, said that dealing with a health issue they couldn’t afford to properly treat affected their work. As one study participant’s experience makes clear, delaying care can make everyday tasks difficult: “I had to put off cataract surgery for quite some time until I could save enough money to have the surgery. I could not see my work. I literally had to have my boss read emails out loud to me or even write the emails herself because I could not see. We were video chatting 90% of the day. I had to use a magnifying glass to read the screen.”

Of study participants, 17 percent ultimately decided to leave a job to afford better healthcare. Some participants said that they left jobs they liked merely because of healthcare costs. One study participant shared, “This is actually one of the jobs that I’ve loved the most. I love so many things about this job. But the doctor told me to try a new medication [for Diabetes] and it was $285 a month with this insurance. So I was like no, I can’t with this insurance. It’s one of the main reasons that I’m looking for a new job.”

Policies to Improve Employer-Sponsored Health Insurance

This study illuminates the human costs of employer-sponsored health insurance, the social and mental toll that delaying care exacts on people, and the downward spiral that not being able to afford healthcare can provoke.

Several market trends—such as rapidly increasing premiums, the rising number of high-deductible health plans, more costly healthcare products and services, surging prescription drug prices, and the consolidation of corporate insurance providers—are driving up prices for workplace-sponsored healthcare beyond what most workers can afford. To make employer-sponsored health insurance more affordable, policymakers must create multipronged approaches that simultaneously address all the drivers of inflated healthcare costs.

According to the Commonwealth Fund, which conducted a similar study on healthcare affordability in October of 2023, no matter what type or extent of coverage people have, protecting consumers from financial ruin due to medical debt—which would involve curtailing aggressive medical bill collection practices, removing medical debts from credit score determinations, and giving people more time and lower rates of interest to pay off medical debts—is one of the most effective ways to relieve the burdens associated with our current healthcare system’s exorbitant costs.

Another solution put forward by the Commonwealth Fund is to lower healthcare cost growth by limiting how much healthcare consumers can be charged for health insurance premiums, pharmaceuticals, healthcare services, medical devices, and other health expenses.

Of course, better public healthcare options and increased access to federal insurance programs would make fewer Americans reliant on private employer-sponsored health insurance programs that take too much from workers and ultimately give too little in return.