Women with Employer Sponsored Health Insurance Face Affordability Issues

January 04, 2023 - Among people with employer-sponsored health insurance, women were more likely to report being unable to afford healthcare than men, according to a study published in JAMA.

In addition to facing unique challenges in accessing and affording healthcare, women often have higher healthcare needs. At the same time, healthcare policy changes and a shifting economy may have impacted healthcare affordability for women and men.

Employer-sponsored health insurance is a common source of healthcare coverage. In 2019, 61 percent of all non-elderly adults in the US received health insurance coverage through their employer.

Researchers used National Health Interview Survey (NHIS) data from 2000 to 2020 for adults between 19 and 64 who obtained healthcare coverage through an employer or union to determine reported differences in healthcare affordability between men and women.

The study sample included 238,852 adults with employer-sponsored health insurance: 127,192 women and 111,660 men.

Although the share of people reporting unaffordability was low, women were more likely to be unable to afford healthcare services than men.

For example, 3.9 percent of women said they could not afford medical care compared to 2.7 percent of men. Similarly, 5.2 percent of women reported unaffordability for prescription medication compared to 2.7 percent of men.

Mental healthcare had the lowest share of women (2.1 percent) and men (0.8 percent) reporting unaffordability, while dental care had the highest share, with 8.1 percent of women and 5.4 percent of men saying they could not afford it.

Reported unaffordability increased for men and women between 2000 and 2009 through 2010, classified as trend 1. Between 2009 through 2010 and 2013 through 2017, defined as trend 2, reported unaffordability decreased before increasing again through 2020.

Reported unaffordability followed this trend for most services among men and women. However, less than 2 percent of women consistently reported being unable to afford mental healthcare from 2000 to 2017, with the figure increasing from then on.

Researchers conducted sensitivity analyses that excluded 2019 and 2020 data and found similar results.

A higher share of women than men still reported unaffordability for medical care, dental care, prescription medication, and mental healthcare. One difference from the primary analysis was that the share of women reporting unaffordability for mental healthcare services declined from 2010 to 2015 before increasing again.

“Lower income and higher healthcare needs among women could be driving sex differences in reported affordability,” researchers wrote.

Despite fluctuations, the study period ended with unaffordability for healthcare services increases for both women and men, indicating that employer-sponsored health insurance may not offer coverage for all needed care.

The Affordable Care Act helped improve coverage and affordability by expanding employer-sponsored health insurance coverage to uninsured young adults through its dependent coverage provision, introducing maternal care coverage, and eliminating cost-sharing for preventive services.

However, other factors continue to negatively impact the affordability of employer-sponsored plans, including rising healthcare costs, increased out-of-pocket spending, and the growth in high-deductible health plans.

The study findings suggest that employers may need to redesign their healthcare offerings to reduce affordability differences between men and women.

According to data from the Kaiser Family Foundation (KFF), women with employer-sponsored health insurance were more likely than Medicaid beneficiaries to discover that certain services they thought were covered were not.

In addition, women were more likely than men to find that their payers would not cover a provider-recommended test and that their prescription medication was not covered or had high cost-sharing.