Latest findings provide assessment of enrollees’ health status, affordability challenges within the country’s largest insurance market
Many Americans who depend on employer-sponsored health care are managing complex, costly health conditions and face significant gaps in diagnosis and disease management across race, ethnicity and income levels, according to a new analysis from Morgan Health and NORC at the University of Chicago. 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.
More than 150 million Americans depend on employer-sponsored insurance (ESI) for their health care. While the national focus on health inequities has centered on the U.S. population at large, the health status of ESI enrollees has not been well understood given historical data gaps and limitations in analyzing health outcomes across race, ethnicity and income.
“These findings are a wake-up call for business leaders on the severe health disparities that exist across the country’s workforce,” said Dan Mendelson, Morgan Health CEO. “The business community has a responsibility to understand and recognize these disparities, and more importantly, act to eliminate them. This will require active engagement with health plans and providers to close gaps and improve health outcomes.”
The Morgan Health-NORC analysis reflects the latest data on ESI enrollees from three nationally-representative, public surveys and national vital statistics records. 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.
The burden of chronic disease varies significantly across races with data revealing underdiagnosis of key conditions for certain patient populations.
- 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. After adjusting for age and sex, Black enrollees were 16.7 percentage points more likely to have high blood pressure than white enrollees. Furthermore, Black enrollees were 15.6 percentage points more likely than white enrollees to have uncontrolled high blood pressure.
- 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. The rate of undiagnosed diabetes was approximately 3 percentage points higher for Asian, Hispanic and Black enrollees than white enrollees.
- 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.
Widespread variation in Cesarean section (C-section) delivery rates among races reinforce persistent maternal health gaps within the ESI market. Studies have shown that C-section delivery can significantly reduce maternal morbidity and mortality in high-risk deliveries. However, when performed in low-risk situations, C-sections can increase the risk of infections and blood clots and may contribute to unnecessary postpartum complications including death.
- The analysis showed that 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.
- After adjusting for differences in age, Black, Asian and Hispanic enrollees with low-risk pregnancies were more likely to undergo a C-section than their white counterparts by 6.5, 3.9, and 3.4 percentage points, respectively.
Behavioral health and substance use issues were prevalent among all enrollees, however, there were stark differences in severity of these issues and related outcomes for Lesbian, Gay or Bisexual enrollees.
- 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.
- 19.8 percent of enrollees used tobacco products (inclusive of smoking, vaping, chewing tobacco), 30.1 percent reported heavy alcohol use, and 18.8 percent used illicit drugs, such as marijuana, cocaine, crack, heroin, misuse of pain relievers, stimulants, and tranquilizers, to name a few. Heavy alcohol use was highest among Hispanic enrollees while illicit drug use was highest among white enrollees.
Despite perceptions around the robustness of coverage within ESI, enrollees experience significant barriers to accessing care, particularly for those of racial/ethnic minority backgrounds and individuals with low or modest incomes.
- Specifically, 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.
- While nearly all enrollees (91.5 percent) reported having have a usual source of care, the analysis showed significant differences in emergency department (ED) utilization – a proxy measure for care accessibility.
- After adjusting for age and sex, Black enrollees were 4.9 percentage points more likely than white enrollees to have visited an ED; in contrast, Asian enrollees were 4.5 percentage points less likely than white enrollees to have visited an ED.
- After adjusting for age and sex, enrollees in the lowest income bracket (under $50,000) were 7.1 percentage points more likely than enrollees in the highest income bracket ($150,000 or more) to have visited an ED.
Even with employer-sponsored coverage, some enrollees have unmet social needs that can further exacerbate gaps in health outcomes.
- More than 7 percent of enrollees were food insecure. After controlling for age and sex, Black and Hispanic enrollees were more likely than white enrollees to be food insecure (by 9.8 and 6.0 percentage points, respectively).
As part of its commitment to improving the quality, equity and affordability of employer-sponsored health care, Morgan Health is developing new accountable care models and quality measures with the goal of mitigating any observed disparities. For example, our partnership with Kaiser Permanente will include both companies jointly collecting and reporting health equity metrics for JPMorgan Chase employees in California with plans to introduce performance guarantees tied to health equity on certain quality measures beginning in 2023.
About Morgan Health
Morgan Health is a JPMorgan Chase business unit focused on improving employer-sponsored health care. Through its investments and the advancement of accountable care, Morgan Health is working to improve the quality, equity and affordability of employer-sponsored health care for JPMorgan Chase employees, their families and the U.S. health system. The business is led by Dan Mendelson, CEO of Morgan Health, reporting to Peter Scher, Vice Chairman of JPMorgan Chase & Co. and a member of the firm’s Operating Committee. Morgan Health is headquartered in Washington, D.C. Visit morganhealth.com
About NORC at the University of Chicago
NORC at the University of Chicago conducts research and analysis that decision-makers trust. As a nonpartisan research organization and a pioneer in measuring and understanding the world, we have studied almost every aspect of the human experience and every major news event for more than eight decades. Today, we partner with government, corporate, and nonprofit clients around the world to provide the objectivity and expertise necessary to inform the critical decisions facing society.