More than 150 million Americans get their health insurance from a job, making it the primary way people in the U.S. get coverage. STAT is examining this crucial source of insurance to understand how and why it is becoming unaffordable for workers and their families across the country.
Health benefits are fading away at small companies
Nearly all large companies offer health insurance. But fewer than 60% of smaller firms, with 200 or fewer workers, now offer insurance, an all-time low. The costs of health insurance are pushing small businesses — beloved by politicians and the bedrocks of entire communities — to a financial cliff. Watering down their insurance plans, or deciding not to offer insurance at all, makes it more difficult for these businesses to retain employees.
Offering insurance comes with huge out-of-pocket costs and unwelcome surprises
Even though most small businesses still offer health insurance, they are burdened most by the costs. Deductibles are more than 50% higher at small firms compared with larger companies. Small businesses also could face unexpected surcharges from insurance companies if the number of workers who enroll increases too much.
Premiums are rising much faster than inflation
Federal data show that employers and workers collectively contributed $132.5 billion toward health insurance premiums in 1987. By 2024, that rose to more than $1.4 trillion, vastly outpacing inflation. If premiums tracked inflation perfectly over that time period, employers and workers would have contributed $365 billion. Even when adjusting for average annual payrolls, job-based health coverage has feasted relentlessly on workers’ earnings.
Entrepreneurs and mom-and-pop shops increasingly rely on ACA plans
Half of all people who buy coverage on the Affordable Care Act’s marketplaces work for small businesses or are self-employed, compared with roughly 28% in 2022. This coverage has become a lot more expensive after Congress did not renew enhanced subsidies that lowered people’s costs.
The whistleblower who has become one of America’s most influential health care critics
Chris Deacon used to oversee New Jersey’s health plan for state workers. She discovered the state’s health insurance company was not living up to its promises and was deliberately overpaying for care, so she blew the whistle. But New Jersey specifically cut out Deacon from one of the largest settlements involving employer health insurance. She’s ascended to become one of the country’s most outspoken critics of the health care system, explaining how employers routinely get taken advantage of.