Employer-funded health insurance does not adequately cover all health services for many: report

Many Americans, especially women, struggle to pay for the health care they need—particularly dental and mental health care—even though they have health insurance through their employers.

This is according to a report recently published in the Journal of the American Medical Association (JAMA).

“Many Americans get their health insurance coverage through their employers, but the health insurance plans offered to workers provide fewer benefits than in the past,” said José A. Pagán, professor and chair of the Department of Public Health Policy and Management at the NYU School of Global Public Health , Fox News Digital said in an interview.

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He is co-author of the new article published in JAMA.

“There is a tremendous amount of waste in the system, and that cost is passed on to everyday American workers,” said Dr. Marty Makary, a Fox News medical officer and professor of health policy and management at the Johns Hopkins School of Public Health in Baltimore, Maryland.

A new study published in JAMA found that about 61% of working-age Americans had health insurance through their employers in 2019, according to the study's press release.

A new study published in JAMA found that about 61% of working-age Americans had health insurance through their employers in 2019, according to the study’s press release.
(iStock)

According to the study’s press release, about 61% of working-age Americans received health insurance coverage through their employer in 2019.

Out-of-pocket healthcare spending continues to rise.

The Affordable Care Act improved coverage in employer-sponsored insurance plans by including coverage for maternity care, helping uninsured young adults get coverage from their parents’ coverage, and eliminating co-payments and deductibles for preventive care, the press release added.

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But expenses continue to rise.

More and more women left out medical care

Researchers analyzed data in the National Health Interview Survey.

It is a nationally representative annual survey conducted by the Centers for Disease Control and Prevention (CDC), according to the press release.

A young pregnant woman visits her doctor.  For a new study, researchers evaluated over 238,000 adults ages 19 to 64 who received health insurance coverage through an employer or union from 2000 to 2020.

A young pregnant woman visits her doctor. For a new study, researchers evaluated over 238,000 adults ages 19 to 64 who received health insurance coverage through an employer or union from 2000 to 2020.
(iStock)

The researchers evaluated over 238,000 adults between the ages of 19 and 64 who received health insurance through an employer or union from 2000 to 2020.

The study found that about 6% of U.S. women who had employer-sponsored insurance skipped medical care they needed in the past year because of expenses in 2020 — double the 3% percentage in 2000.

Fewer men said ski jumping required medical care due to affordability: that number was just 3% in 2020 compared to 2% in 2000.

Many dental and psychiatric services are priceless

Mental health and dental services were particularly unaffordable for a subgroup of Americans, particularly women.

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The researchers also found that the number of women unable to afford mental health care has tripled in recent years from around 2% to over 6%.

According to the press release, “The inability of men and women to afford dental services remained the highest each year from 2000 to 2020.”

A dentist at work.  A new study has found that "the inability of men and women to afford dental services remained the highest every year from 2000 to 2020," as stated in the press release of the study.

A dentist at work. A new study found that “the inability of men and women to afford dental services remained the highest of all services every year from 2000 to 2020,” according to the study’s press release.
(iStock)

“Lower incomes and higher health care needs of women may be driving these disparities in reported affordability,” added lead author Avni Gupta, a graduate student in the Department of Public Health Policy and Management at the NYU School of Global Public Health, according to the press release.

“Employer-sponsored insurance plans need to redesign their benefit packages to reduce gender disparities.”

“The primary limitation of the study is that the survey does not include questions to delve deep into the causes of increasing healthcare unaffordability,” Pagán told Fox News Digital.

“Employer-sponsored insurance plans need to redesign their benefit packages to reduce gender disparities.”

“The latest available data is from 2020, but unaffordability trends may have further intensified as a result of the COVID-19 pandemic,” he also said.

Why are health services less affordable?

The lack of providers is partly responsible for the fact that many people cannot afford health services, Pagán told Fox News Digital.

“Since 2020, which coincides with the years of the COVID-19 pandemic, it has been particularly difficult to find mental health providers,” he added.

Woman in a doctor's office about to be vaccinated. "The main limitation of [new] study is that the survey does not contain questions to delve deep into the causes of the increasing unaffordability of health care," DR. José A. Pagán to Fox News Digital.

Woman in a doctor’s office about to be vaccinated. “The main limitation of the [new] study is that the survey does not include questions to delve deep into the causes of increasing healthcare unaffordability,” said Dr. José A. Pagán to Fox News Digital.
(iStock)

“The bottom line is that many middlemen are getting rich at the expense of everyday American workers,” adds Makary, who writes at length about this in his latest book, The Price We Pay.

He notes that pharmacy retirement plans “are the biggest waste area.”

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In New York state, health brokers take 4% of every dollar spent on health insurance premiums, he found.

At a company Makary co-owns, “we pay $220/month per person for health insurance through Sedera,” he said, “which is about half the cheapest Obamacare swap option.”

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“Companies get ripped off and don’t have the time to thoroughly evaluate all options,” he added.

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