How Affordability Challenges Reveal Care Disparities for ESI Members

Employees in employer-sponsored health plans face significant care disparities based on income, sexual orientation, and race that influence health outcomes for each group, a report from Morgan Health uncovered.

Researchers assessed 2021 data from the National Health Interview Survey (NHIS), National Study on Drug Use and Health (NSDUH), and the National Vital Statistics System (NVSS). They used this data to assess the rate of disparities between different employee populations.

First, the researchers explored the impact of income on care disparities. They found that employees with lower incomes were more likely to visit the emergency department, even though health plans generally want to steer patients away from this site of care.

This pattern may be tied to lower-income employees lacking a usual source of care or a primary care provider. Only 4.4 percent of those with incomes of $50,000 or lower had a usual source of care, despite 91.3 percent of all employees with employer-sponsored coverage having a usual source of care.

Employee groups with incomes of $150,000 or lower were more likely to report difficulties covering medical bills and skipping medications due to affordability challenges. Delaying or foregoing prescription refills and reducing medication dosages to save money were more common among low-income groups.

Individuals in lower-income groups were more likely to view preventive care—such as screenings and vaccines—as optional. The influenza vaccination rate and the cervical cancer screenings in the lowest income bracket were 20 points and 12.5 points lower, respectively, than the higher income brackets.

Utilization of mental healthcare services and substance abuse might shed light on the impact of disparities on low-income employees. Lower-income groups’ rates of visiting a provider for their feelings were 7.9 points higher than in the higher-income groups. Substance abuse was significantly higher in lower-income groups as well.

Second, the report assessed care disparities based on sexual orientation. LGB employees have higher rates of severe psychological distress and major depression. They also were more likely to use alcohol and illicit drugs compared to their straight counterparts. As a result, there was higher mental healthcare use in this community.

“While this suggests there is less stigma associated with mental health care among LGB individuals, the extent of mental health and substance use burden remains significant,” the report explained.

Third, the report found that non-White employees had lower rates of certain mental health conditions and substance abuse or dependence than their White counterparts.

The rates of serious psychological distress and major depressive episodes were much higher among White individuals. Additionally, 17.8 percent of White employees experienced alcohol abuse or dependence compared to 17.3 percent of Hispanic employees, 16.3 percent of Black employees, and 9.5 percent of Asian employees.

The Asian population was the least likely to seek out mental healthcare. Only 6 percent of Asian employees with depression obtained mental health treatment and only 13.2 percent of Asians with depression visited a provider.

Black employees were more likely to leverage preventive care benefits than their White counterparts except for receiving the flu shot. But they had more difficulty covering medical bills. Similarly, while Hispanic employees were more likely to keep up with their wellness visits than White employees, they were more likely to delay medical treatment due to affordability challenges.

Lastly, the report highlighted that cesarean deliveries were more common among non-White employees than White employees. Low-risk c-sections were also less common for White employees than for employees of other races.

Based on these findings, the researchers offered six recommendations. They suggested using financial incentives to improve primary and preventive care rates, tailoring preventive care services by population, expanding mental healthcare and substance abuse care with a particular focus on the LGB community, leveraging employee resource groups, integrating doula and midwife services into coverage, and offering price transparency tools to help employees find affordable care.

While many of these findings align with trends in the health insurance industry overall, they may be jarring when set beside employee satisfaction numbers. According to AHIP, 93 percent of employees were satisfied with their employer-sponsored health plans. Top health plan descriptors that employees named included “affordable” and “comprehensive.”