Employers collectively spend $1 trillion for health care each year. And amidst a tight and competitive labor market, many employers are increasingly interested in ensuring that their health care offerings are high quality, affordable and personalized to help people better access the care they need, when they need it. Despite these efforts, data shows that disparate outcomes exist – underscoring the importance of a more targeted focus.
Morgan Health’s report, Quality and Outcomes Gaps in Employer-Sponsored Insurance (ESI),is our third consecutive analysis of the latest publicly available data1 (2022 and 2023) from the employer sector and continues to show that factors such as income level, sexual orientation and race are associated with significant variations in both health care access and outcomes. When left unaddressed, these factors can create conditions that impact employee well-being, such as unmanaged chronic diseases, increased hospitalizations and emergency room (ER) visits, reduced quality of life and lower productivity – all of which hamper business success. Consider, for example, when an employee faces difficulty paying for needed care. Missing a doctor visit or skipping a prescription refill can lead to time in the ER or more severe health conditions down the road and missed work.
We provide visibility into these gaps in care, so employers have a better understanding and appreciation of examples where health outcomes are notably lagging. By addressing core affordability and quality challenges, employers will be able to drive towards higher quality, more accessible health care experiences for their employees. In turn, businesses can realize a meaningful return in the form of healthier employees, stronger staff satisfaction and retention, downstream health care cost savings (i.e., disease prevention and hospital/ER avoidance) and more healthy days. Each of these metrics help sustain business growth.
Here’s what the 2025 report shows:
1 Three nationally representative surveys - 2023 National Health Interview Survey (NHIS), 2022 National Study on Drug Use and Health (NSDUH), and the 2023 National Vital Statistics System (NVSS)
Key findings:
- Mental health burden has worsened over time, with notable gaps in treatment for underserved populations.
- Food insecurity has worsened over time in the ESI population.
- Primary and preventive care are not being accessed by low-income individuals and are inconsistently accessed by Black and Hispanic groups, leading to over reliance on emergency services.
- Lower-income people with ESI have pronounced gaps in access and financial hardship associated with medical care.
- Racial disparities in maternal health persist.
Lesbian, Gay and Bisexual (LGB) people are more severely burdened by mental health challenges.
The prevalence of LGB people facing depression increased 3.1%, while those experiencing psychological distress increased by 10.6% from 2021 to 2022. And while LGB people continue to access mental health care at rates higher than their Straight counterparts, there is a pattern of reduced care use during this period even as mental health worsens. Alarmingly, among those who reported experiencing a depressive episode in the prior year, the percentage of LGB individuals receiving either counseling or prescription treatment decreased from 74% to 54%, while the Straight counterparts’ care usage also decreased, but by less (55% to 46%).
Recommendation for employers: Find opportunities to help employees better navigate their benefits to connect with professionals who can support mental health needs.
Food insecurity is becoming a larger issue for people with employer-sponsored insurance.
With higher than usual grocery bills in recent years, food insecurity has worsened across the employer-sponsored insurance population. In 2021, 5.9% of individuals with ESI experienced some degree of food insecurity, and this rate has grown to 8.5% in 2022. There was no improvement in 2023. In fact, there was a slight shift from marginal food insecurity to more severe levels of low or very low food security in 2023.
Food Insecurity in ESI
Recommendation for employers: Expand benefits coverage to include prescription food boxes.
Black and Hispanic people engage less with primary and preventive care, more frequently rely on emergency services.
Although Black and Hispanic people report having a usual source of care at a high rate (~90%), that doesn’t translate to high engagement with primary and preventive care. Compared to their white counterparts, Black and Hispanic people have lower rates of receiving the flu vaccine (Black: -6%; Hispanic: -5%) and visit the ER at higher rates (Black: +5%; Hispanic: +2%). And while gaps have closed in some preventive measures like mammography screening rates, there are still racial disparities in cervical cancer screening rates compared to white women: Black women (-6%), Hispanic women (-12%) and Asian women (-24%).
Recommendation for employers: Provide access to provider quality guides to drive appropriate care utilization.
People with lower incomes continue to forego needed health services due to costs.
In 2023, 11% of people making less than $50,000 delayed medical care due to affordability challenges – while 9% avoided necessary medical care, and 14% skipped, delayed or did not adhere to prescriptions. It’s worth noting that people in higher income brackets also reported affordability as a barrier to medical care and prescriptions. Among people making $75,000 - $99,999, 6% delayed medical care, 5% avoided necessary care and 10% faced prescription related financial hardship.
Financial Hardship by Income Level
Recommendation for employers: Offer health plans and pharmacy benefits with graduated premiums or reduced cost sharing.
Black and Hispanic women experience poorer quality of labor and delivery care.
Maternal health disparities continue to persist – with both Black and Hispanic women having c-sections at rates higher than white women (9% and 4% higher respectively). And when considering low-risk pregnancies where c-sections are not often medically necessary and can pose additional complications, Black women (+7%), Hispanic women (+4%), and Asian women (+5%) have low-risk c-sections at higher rates than their white counterparts.
Recommendation for employers: Advocate for payers to incorporate doulas and midwifery services into their provider networks.