July 2023Health disparities in employer-sponsored insurance

In 2022, Morgan Health worked with NORC at the University of Chicago to analyze the latest data on employer-sponsored insurance (ESI) enrollees from three nationally representative, public surveys and national vital statistics records.

We learned that even among those with ESI, patients face significant gaps in diagnosis and disease management across race, ethnicity and income levels. Further, for employed individuals with low- and moderate-incomes, the high cost of care and insurance, including deductibles and out-of-pocket costs, forced many to forgo or delay necessary medical treatments.

Figure A: Unadjusted prevalence of high blood pressure among enrollees, by race and ethnicity. 60.4 percent of Black enrollees, 46 percent of white enrollees, 44.2 percent of Hispanic enrollees, and 40.7 percent of Asian enrollees had high blood pressure. Source: 2017-March 2020 NHANES (CDC/NCHS).

The findings present an important snapshot of health outcomes and disparities prior to the onset of COVID-19. Some of the most significant disparities appear to be associated with income differences, while others vary by race and sexual orientation, even when controlling for other factors.

“In order to address health disparities, we must first understand the scale, scope, and source of the challenges we’re trying to address. This research gave us a deeper understanding of the unmet health needs within employer-sponsored insurance and identified where employers can dig in and take a more active role in supporting their employees”

Katie Bobroske Vice President, Morgan Health

Key findings:

The burden of chronic disease varies significantly across races

  • Blood pressure: 60.4 percent of Black enrollees, 40.7 percent of Asian enrollees and 44.2 percent of Hispanic enrollees had high blood pressure, compared to 46.0 percent of white enrollees.
  • Diabetes: Compared to white enrollees, Asian, Hispanic and Black enrollees were more likely to have diabetes by 6.9 percentage points, 5.6 percentage points, and 5.3 percentage points, respectively, after adjusting for age and sex.
  • Obesity: 42.8 percent of enrollees were classified as obese. After adjusting for age and sex, Black enrollees were more likely to be obese than white enrollees by 13.6 percentage points, while Asian enrollees were less likely to be obese than white employees by 26.2 percentage points.

There is widespread variation in Cesarean section (C-section) delivery rates among races

  • 20.1 percent, 17.7 percent, and 17.0 percent of low-risk deliveries among Black, Asian and Hispanic enrollees, respectively, were performed via C-section, compared to a rate of 13.6 percent among white enrollees.

Behavioral health and substance use issues were prevalent

  • The overall rates of anxiety and depression within ESI were 13.3 percent, and 14.1 percent, respectively.
  • After adjusting for age and sex, white enrollees were more likely than Black, Hispanic and Asian enrollees to experience serious psychological distress, by 2.0 percentage points, 1.8 percentage points, and 5.2 percentage points, respectively.
  • The percent of Lesbian, Gay or Bisexual enrollees who reported serious psychological distress was 12.1 percentage points higher, the rate of anxiety was 16.6 percentage points higher and the rate of depression was 18.4 percentage points higher than for straight enrollees after adjusting for age and sex.

Enrollees experience significant barriers to accessing care

  • 6.9 percent of enrollees reported missing medical care due to cost, 9.8 percent reported missing prescriptions due to cost, and 11.9 percent reported difficulty paying medical bills. These numbers vary widely by income.