Job-related health coverage flattens wages, increases inequities
Costs for employer-based insurance are eating up a larger portion of worker paychecks and worsening income inequality, new research says.
Published Jan. 16 in JAMA Network Open, the study found that growth in premiums for employer-based health insurance has outpaced growth in worker wages for more than three decades.
In 1988, health insurance costs represented about 8% of total worker compensation, defined as wages plus health care premiums. By 2019, that number had risen to almost 18% — a 125% increase.
Those increases did not hit all workers equally. By 2019, health care premiums accounted for 13.8% of compensation for white families, compared to 18.5% for Asian families, 19.2% for Black families, and 19.8% for Hispanic families.
For high-wage workers, who ranked in the 95th percentile for annual earnings, health insurance premiums made up about 4% of compensation. But for low-wage workers, health insurance premiums ate up almost a third of their compensation.
Across the 31-year study period, increases in employer-based health insurance premiums cost workers more than $125,000 per family, or nearly 5% of their total earnings. Real wages — which adjust for inflation and purchasing power — have grown little in recent decades, with the federal minimum wage last increased in 2009.
Affording health care is difficult for many U.S. adults, and especially people of color, polling from KFF has found. About 39% of white adults surveyed in 2022 reported that they had problems with health care costs, compared to 65% of Hispanic adults and 60% of Black adults. Low-income workers were three times more likely to report difficulties with health care costs than high-income workers.
The number of Americans covered by employer-based health insurance has swollen in recent decades, thanks in part to the Affordable Care Act. In 1988, 44.7 million people were covered by employer-based health insurance, compared to 159 million people under age 65 in 2022 — almost half the U.S. population. Signed into law in 2010, the ACA requires companies with 50 or more employees to provide basic health insurance coverage.
Indoor air can be harmful to health
Indoor air pollution can pose dangers to human health, with children and older adults at greater risk of harm, a new report from the National Academies of Sciences, Engineering and Medicine finds.
Whether at home, school, work or in another indoor venue, people are exposed to varying levels of fine-particle pollution, also known as PM2.5, on a regular basis, according to the report, which was published Jan. 19.
Indoor air pollution can come from outside sources, such as wildfire smoke that seeps in around windows, and from inside sources, such as gas stoves, fireplaces, candles, smoking, printers and cleaning products. Indoor air can also contain human-exhaled respiratory particles, which may contain bacteria and viruses.
People who live in poorly sealed homes and near sources of vehicle and industrial emissions, such as highways and power plants, are at greater risk of exposure. Communities located in areas with high levels of outdoor pollution — which often comprise people of color and those with low incomes — may experience that pollution indoors as well.
Indoor exposure to PM2.5 has been linked to asthma, cancer, high blood pressure, dementia and chronic obstructive pulmonary disease, among other illnesses. Older adults and people who are immunocompromised are at higher risk for harm from air pollution because of their weakened immune systems. Children are also at higher risk, in part because their airways are still developing and they have more respiratory infections.
In schools, previous research has found that classrooms with windows facing bus loading zones have higher levels of PM2.5. Elevated levels of indoor air pollution in classrooms have been linked to lower performance on learning and concentration tests for children. Given the amount of time kids spend in classrooms, the report authors said it is particularly important to improve indoor air quality at schools.
While outdoor air quality falls under the responsibility of the U.S. Environmental Protection Agency, there is no similar across-the-board authority for indoor air, the report noted. Strategies that can lower exposure to indoor air pollution include air filtration, upgraded appliances and windows, improved ventilation and in some cases, personal protection equipment such as masks.
Poorer quality health care the norm for US children of color
Children of color across the U.S. receive poorer quality care than white children throughout their development, researchers have concluded.
Inequities in care between white and non-white children exist across pediatric health care, including neonatal care, emergency medicine, surgery and mental health care, according to two new papers published last week in The Lancet Child & Adolescent Health.
Researchers reviewed child health studies published in the U.S. over five years, determining that federal, state and local policies perpetuate structural racism, leading to disparities in pediatric health care. The review was limited to studies that controlled for health insurance status, allowing researchers to rule out lack of access to health care as a driver of the disparities.
Disparities in care for children of color occur even before newborns leave the hospital, the researchers found. For example, low birthweight Black and American Indian infants are less likely to receive human milk before they are sent home after birth. Sepsis rates are higher for Black and Hispanic babies than white babies, as are potentially avoidable health complications for newborns.
Later in life, Black and Asian children with developmental disabilities are less likely to be diagnosed before preschool or kindergarten. Children of color are less likely than white kids to receive pain medication when they have a broken arm or leg, appendicitis or migraine. Parents of Black children are less likely to receive recommendations for HPV vaccination than parents of white children. Black and Hispanic children are less likely than white patients to receive chest X-rays during emergency visits for asthma.
Disparities exist even for children who are dying, the researchers found. Medically intense treatment, which can increase suffering, is more common for Hispanic children during their final days of life. Black, Hispanic and Asian American children who receive palliative care — which is aimed at providing comfort and pain relief — are more likely to die in the hospital than white children.
Poor-quality communication between health providers and children and parents of color contributes to ongoing inequities, said the researchers, who were affiliated with pediatric departments, medical colleges, research centers and other health-related programs at more than a dozen institutions. They called for widespread policy reform and health system redesign to help eliminate inequities in care for children of color.
The Watch is written by Michele Late, who has more than two decades of experience as a public-health journalist.
