Data Shows Lack of Health Equity in Employer Sponsored Health Plans

Data on employees continues to exhibit care disparities that signal a lack of health equity in employer-sponsored health plans, according to a report from NORC at the University of Chicago (NORC) commissioned by Morgan Health.

The researchers used 2019 data from the National Health Interview Survey, National Health and Nutrition Examination Survey (NHANES) data from 2017 through March 2020, and National Survey of Drug Use and Health (NSDUH) data from 2019 as well as natality vital statistics registry data from 2020. 

In total, the researchers analyzed data for over 12,300 adults with the NHIS data, more than 3,100 adults from NHANES, and 14,580 adults from the NSDUH data, all between the ages of 25 and 64.

Care disparities were present for employer-sponsored health plan enrollees with three key chronic conditions in the US, two of which are among the top ten most expensive chronic diseases in the nation.

Diabetes was highly prevalent among the minority groups that the researchers observed, more so than among White employer-sponsored health plan enrollees. 

For White enrollees, the rate of diabetes was 8.8 percent. In contrast, the share of Asian enrollees with diabetes was 14.1 percent. Among Black enrollees, the share was 13.4 percent and Hispanic enrollees had a 13.3 percent rate of diabetes. Moreover, undiagnosed diabetes was higher among employer-sponsored health plan enrollees who identified as part of a minority.

Obesity also presented care disparities in employer-sponsored health plan coverage. More than half of all Black enrollees (56.2 percent) and over 46 percent of Hispanic enrollees in employer-sponsored health plans were considered obese, compared to 43 percent of White enrollees.

High blood pressure was most prevalent among Black enrollees, with slightly more than six out of ten Black enrollees reporting high blood pressure. White enrollees had the second-highest rate of high blood pressure, with 46 percent having high blood pressure. Hispanic enrollees followed (44.2 percent) with Asian enrollees having the lowest rate of high blood pressure (40.7 percent).

Care disparities in maternal health are well-documented. The report found that racial care disparities are prevalent in maternal healthcare covered by employer-sponsored health plans, just as they are for maternal healthcare covered by other payers. All of the minorities that the report studied saw higher rates of low-risk C-sections—an unnecessary C-section that can increase the risk of postpartum complications and death—than the White population.

A fifth of all Black enrollees’ low-risk pregnancies ended in C-sections. Among Asian enrollees, the rate was 17.7 percent and the procedure occurred in 17.0 percent of low-risk pregnancies for Hispanic enrollees. In contrast, 13.6 percent of White enrollees with low-risk pregnancies experienced a C-section.

In contrast to the other findings, White enrollees had the highest rate of behavioral healthcare diagnoses of serious psychological distress, anxiety, and depression. White enrollees had a higher rate than Black enrollees by 2.0 percentage points for serious psychological distress, 9.6 percentage points for anxiety, and 8.8 percentage points for depression.

“Higher utilization of mental health care may explain the higher prevalence of diagnosed serious psychological distress among white enrollees,” the report noted.

Among lesbian, gay, and bisexual individuals, the rate of behavioral healthcare diagnoses was higher than among straight individuals as was substance use. Heavy alcohol use was 40 percent among enrollees who identified as lesbian, gay, or bisexual and 30 percent among straight enrollees. Illicit drug use was 44.5 percent among individuals who identified as lesbian, gay, or bisexual and 17.6 percent among straight individuals.

Substance use was highest for Hispanic enrollees, a third of whom reported heavy alcohol use. White enrollees and Black enrollees followed closely behind, with 31.7 percent and 27.1 percent reported heavy alcohol use for each.

Illicit drug use was highest for White enrollees (20.6 percent), followed by Hispanic enrollees (16.6 percent) and Black enrollees (16.4 percent).

The report also covered financial barriers to care including food insecurity. Food insecurity was 6.2 percentage points higher among Black enrollees than White enrollees when adjusted for age, sex, and income. It was 6.0 percentage points higher among Hispanic enrollees when compared to White enrollees after similar adjustments.

“For employers providing health benefits and coverage to their employees, the prevalence of health disparities across race, ethnicity and income undermines the strength and resiliency of our nation’s workforce,” the report concluded. 

“The stark health disparities across subpopulations requires the urgent attention of the business community. Business leaders need to understand and recognize these disparities, and importantly, act to eliminate them.”

Business groups have been urging employers to take more responsibility for social determinants of health. Solutions for integrating health equity into employers’ chronic disease management strategies have also been circulating.