Improving Equity in Employee Health Benefits

Access to medical benefits is inequitable based on income, according to the Bureau of Labor Statistics (BLS)’s “National Compensation Survey,” released in March.

BLS found 39% of private-industry employees in the lowest 25% of income groups—defined as those having an average hourly wage of less than $15—had access to employer medical benefits. On the other end of the spectrum, among those in the highest 25% of income groups—defined as those having an average hourly wage of $32.20 or greater—93% had access to employer medical benefits.

However, access to medical benefits is only part of the problem.  Reports of delaying treatment for a serious medical condition jumped 13 percentage points from 2018 to 2019 among adults in households earning less than $40,000 per year, according to a Gallup poll of 1,015 adult Americans.

These lower-income employees are not afforded equal levels of accessible care and, as a result, are more likely to experience higher levels of physical, mental and financial anguish than their higher-paid counterparts, according to Julie Stich, vice president of content at the International Foundation of Employee Benefit Plans (IFEBP), in Brookfield, Wisconsin. “They’re likelier to experience lower life expectancies, infant health mortality, differences in COVID-19 death rates, higher instances of diseases such as diabetes or heart disease, higher incidence of mental health challenges such as anxiety and depression, and difficulty in getting access to quality medical or mental health care,” she says.

A lack of paid time off (PTO), access to transportation, health care education or ability to find the right provider are additional barriers for these workers, says LuAnn Heinen, vice president at the Business Group on Health, in Minneapolis. With multiple hurdles in their path, low-wage workers are more likely than those with higher salaries to experience delayed diagnoses and severe mental and financial constraints.

Income level is not the only factor that can affect health benefit equity. Black, Indigenous and people of color (BIPOC) workers are more likely to face these issues than their white counterparts, especially when searching for culturally similar or competent providers, Heinen adds.

“BIPOC workers have a much harder time finding providers,” she says. “For mental health in particular, it’s really important to have a therapist who understands you, where you came from and your cultural context. It’s an advantage to have that.”

Ways to Make Health Benefits More Equitable

According to data from the Business Group on Health, 49% of companies say they are auditing their benefits and well-being initiatives to promote diversity, equity and inclusion (DE&I) strategies in 2021.

To understand the employees’ needs and whether benefits are inclusive, plan sponsors can survey their workforces. Conducting a strategic inventory of benefit offerings and then analyzing their effectiveness can determine the success and affordability of a benefit, Heinen says.

Surveying the employee population also helps plan sponsors figure out whether employees understand each benefit, its purpose and how to use it, says Julie Schweber, a senior knowledge adviser with the Society of Human Resource Management (SHRM) in the Washington, D.C. area.

“A lot of employers do a survey to ensure their workers know what a benefit provides and how to access it,” Schweber says. “Talk to your employees about it in small group meetings and make sure it’s an ongoing conversation.”

Employers may also bring in representatives or wellness professionals to discuss available benefits and the importance of managing health, Schweber adds. For example, some employees might not know that annual physicals or a flu shots are considered preventive care and therefore are provided at no cost. Employers might also provide financial incentives to encourage employee behaviors, she notes.

Employers should also ensure that health benefit communication materials are accessible in a range of formats and languages, Schweber says.

Employers can also consider initiatives to support lower-income groups and traditionally marginalized populations, such as BIPOC and LGBTQ+ workers, Heinen says. Lowering health care and prescription drug costs, creating compensation-based benefits or tiering health care costs based on employee income levels encourage healthy habits without sacrificing additional income. Offering family planning benefits to all workers, including LGBTQ+ and single prospective employees, is also essential to inclusion, she says.

When it comes to health care accessibility, telemedicine and on-site clinics are helpful options to support employees who cannot travel far to a medical appointment, have time constraints or are searching for a specific doctor. According to a Business Group on Health survey on top well-being trends for 2022, onsite clinics are expected to rebound in the next two to three years as more workforces return to the office and more providers visit company sites.

Along with incorporating on-site clinics that support primary and mental health care needs, Heinen anticipates some companies will offer on-site health literacy classes, as well as COVID-19 vaccinations, boosters and testing. Instead of offering several key benefits, Heinen says employers are increasingly focusing on the overall well-being of their employees.

“The framing is shifting to ‘How can we support you? How can we help you with your family needs, or with what you care about?’” she explains. “There is some momentum for focusing on social determinants of health care inequity and promoting quality and access for all, and employers are in a good position to be a big part of that.”

If employers are offering an on-site clinic, they should confirm that employees have time built into their day to pursue appointments without sacrificing pay, Schweber says. “Employees should explore healthy habits without getting docked pay for doing so.” 

These clinics should also include linguistically and culturally appropriate health and wellness programs with trained staff members who can speak at least another language or two, so that all employees can understand their physician and are more comfortable receiving care, Schweber adds.

Stich says employers can also consider providing transportation or helping with ride-hailing services to wellness facilities, offering an employee assistance program (EAP), or giving access to plan choice assistance and coaches to help individuals find clinics nearby.

Employers might want to stop requiring a doctor’s note for paid sick leave if employees are having trouble getting to a physician, Stich suggests. In addition, they could allow employees to donate PTO to one another. “If there are some employees who won’t use all of their paid leave, they can donate it to employees who need the time to take care of their health,” Stich explains.

Health care is inextricably linked to financial wellness, therefore plan sponsors should question what they are doing to help employees with health care costs. Stich encourages plan sponsors to consider seed funding or matching contributions into a flexible spending account (FSA) or a health savings account (HSA) for employees. Employers might also consider ways to help employees build emergency savings or offer an emergency loan with repayment through an automatic payroll deduction to avoid high-cost payday loans, Stich says.

Employers can make their equity and inclusion efforts known to employees in benefits materials. “When you’re putting these brochures and benefit packages together, make sure the photos represent everyone in the workforce,” Schweber says. “It shows that you have considered your diverse workforce.”