For two decades, the implicit contract between American workers and their employer-sponsored health plans has been quietly unraveling. A study from NYU's School of Global Public Health, drawing on data from over 238,000 working-age adults, documents how the gap between holding insurance and being able to afford care has steadily widened — with women bearing the heaviest share of that burden. The findings ask a question that cuts to the heart of how societies organize protection: what does coverage mean when the cost of using it remains out of reach?
Employer Health Insurance Eroding: Study Shows Rising Unaffordability for U.S. Workers
Millions of insured U.S. workers, particularly women, are unable to afford necessary health care services including mental health treatment and dental care despite having employer coverage.
Health-related benefits have been eroding over time
Mark
Why would women face such different affordability challenges than men, even with the same insurance?
Mimi
The research points to two things working together—women tend to earn less than men in the same roles, and they also tend to have higher health care needs overall. So the same insurance plan hits their wallets harder.
Mark
But this is employer insurance, which is supposed to be better than the individual market. What's happening?
Mimi
That's the troubling part. Even the "good" insurance is eroding. Employers have been slowly shifting more costs onto workers through higher deductibles and copays. The Affordable Care Act helped, but it couldn't stop the underlying trend of health care inflation outpacing wage growth.
Mark
The mental health numbers are striking—women's affordability crisis tripled in just a few years. Why so sudden?
Mimi
The study doesn't explain the mechanism, but you can see it happening in real time. Mental health became more visible, more discussed, more people seeking it—and suddenly the cost barrier became obvious. It was always there, but fewer people were trying to access it before.
Mark
So what happens next? Do employers actually redesign these plans?
Mimi
That's the open question. Redesigning means spending more money. In a competitive labor market, some might. But most will probably wait until they have to—until workers start leaving for better benefits elsewhere.
The Pulse
- The safety net covering 61 percent of American workers has developed serious structural holes, with out-of-pocket costs rising relentlessly even as the Affordable Care Act expanded formal coverage.
- Women are being priced out of care at rates nearly double or triple those of men across every service category — medical, dental, prescription, and mental health — despite carrying the same employer coverage.
- Mental health care represents the sharpest crisis point: unaffordability for women tripled in recent years, rising from roughly 2 percent to more than 6 percent, while dental care has never improved for either gender across the full twenty-year period.
- Researchers are calling for structural redesign of employer benefit packages, but that solution collides directly with employers already strained by rising premiums, leaving workers caught in the middle.
- The trajectory is clear and worsening: having insurance no longer functions as a reliable guarantee that necessary care is financially within reach.
For two decades, the implicit contract between American workers and their employer-sponsored health plans has been quietly unraveling. A study from NYU's School of Global Public Health, drawing on data from over 238,000 working-age adults, documents how the gap between holding insurance and being able to afford care has steadily widened — with women bearing the heaviest share of that burden. The findings ask a question that cuts to the heart of how societies organize protection: what does coverage mean when the cost of using it remains out of reach?
For millions of American workers, employer health insurance has quietly stopped delivering on its promise. A new NYU School of Global Public Health analysis, published in JAMA and drawing on twenty years of data from more than 238,000 working-age adults, finds that the ability to actually afford care has steadily eroded — even as formal coverage remained in place.
The gender gap at the center of the findings is striking. Women report being unable to afford medical care at rates nearly 1.5 times higher than men. For dental work, the disparity nearly doubles. Prescription medications and mental health care follow the same pattern, with women consistently facing the steeper climb. Mental health care tells perhaps the most urgent story: women's unaffordability rate tripled in recent years, reaching more than 6 percent, while dental services have remained the least affordable category across the entire period without meaningful improvement for either gender.
Lead researcher Avni Gupta points to lower incomes and higher health care needs among women as key drivers. The conclusion is not that women are avoiding care by choice — they are being priced out of it. Co-author José Pagán frames the broader erosion plainly: workers arrive at their jobs expecting a safety net and are discovering, year by year, that the net has developed tears.
Addressing the gaps would require employers to redesign benefit packages — particularly around mental health and dental coverage — at a moment when rising premiums are already straining budgets. For workers, and especially for women, the finding carries an uncomfortable weight: insurance, it turns out, is no longer the same thing as being able to afford care.
For millions of Americans, the promise of employer health insurance has quietly broken down. A new analysis from researchers at NYU's School of Global Public Health reveals that workers covered through their jobs are finding it increasingly difficult to actually afford the care their plans supposedly protect them against—and the burden falls disproportionately on women.
The study, published in the Journal of the American Medical Association, examined two decades of data on more than 238,000 working-age adults who received insurance through employers or unions. What the researchers found was stark: the safety net that covers about 61 percent of American workers has developed serious holes. Despite the Affordable Care Act's improvements—which extended coverage to young adults, eliminated copays for preventive care, and expanded maternal benefits—out-of-pocket costs have continued their relentless climb.
The gender gap is particularly striking. Women report being unable to afford medical care at rates nearly 1.5 times higher than men (3.9 percent versus 2.7 percent). For dental work, the disparity widens to nearly double: 8.1 percent of women versus 5.4 percent of men. Prescription medications show a similar pattern, with 5.2 percent of women unable to afford them compared to 2.7 percent of men. Mental health care reveals perhaps the starkest divide—2.1 percent of women versus 0.8 percent of men report it as unaffordable.
Over the twenty years examined, the trend has only worsened. In 2000, roughly 3 percent of women found basic medical care unaffordable. By 2020, that figure had doubled to 6 percent. Men saw a similar trajectory, climbing from 2 percent to 3 percent. Mental health care affordability for women deteriorated most sharply in recent years, tripling from around 2 percent to more than 6 percent. Dental services, meanwhile, have consistently remained the least affordable category across the entire period, never improving for either gender.
Avni Gupta, the lead researcher on the analysis, points to a combination of factors driving these disparities. "Lower incomes and higher health care needs among women could be driving these differences," she explained. The implication is clear: women aren't simply choosing not to seek care—they're being priced out of it, even with insurance that's supposed to protect them.
José Pagán, who co-authored the study, frames the broader problem plainly: "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." The erosion is not dramatic year to year, but measured across two decades, it amounts to a fundamental shift in what employer insurance actually delivers. Workers show up to jobs expecting a safety net and discover instead that the net has developed tears.
The research suggests that employer plans need structural redesign—particularly to address the mental health and dental care gaps that have become most pronounced. But that redesign would require employers to absorb higher costs at a time when they're already managing rising premiums. For workers, especially women, the message is becoming unavoidable: having insurance no longer guarantees you can afford to use it.
Notable Quotes
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.— José A. Pagán, co-author of the JAMA analysis
Lower incomes and higher health care needs among women could be driving these differences in reported affordability. Employer-sponsored insurance plans need to redesign their benefit packages to reduce sex-based disparities.— Avni Gupta, lead researcher
Want the full story?
Read the original at News-Medical.net ↗
Education