A new Morgan Health-NORC analysis finds widespread health disparities among Americans with employer-sponsored insurance

WASHINGTON-(BUSINESS WIRE)–Many Americans who depend on employer-sponsored health care cope with complex, costly health conditions and face significant gaps in diagnosis and disease management by race, ethnicity and income levels, according to a new analysis by Morgan Health and NORC at the University of Chicago. Additionally, for low- and moderate-income workers, the high cost of care and insurance, including deductibles and out-of-pocket costs, has forced many to forgo or delay needed medical treatment.

More than 150 million Americans depend on employer-sponsored insurance (ESI) for their health care. While the national focus on health disparities has centered on the US population as a whole, the health status of ESI enrollees is not well understood given gaps in historical data and limitations in analyzing health outcomes by race, ethnicity, and income.

“These findings are a wake-up call for business leaders about the serious health care disparities that exist in the nation’s workforce,” said Dan Mendelson, CEO of Morgan Health. “The business community has a responsibility to understand and recognize these differences 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 most recent data on ESI enrollees from three nationally representative community surveys and national vital statistics records. The findings provide an important snapshot of health outcomes and disparities before the onset of COVID-19. Some of the most significant differences appear to be related to differences in income, while others vary by race and sexual orientation, even when controlling for other factors.

Key Findings:

  • Burden of chronic disease varies widely 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 with 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. Additionally, black enrollees were 15.6 percentage points more likely than white enrollees to have uncontrolled high blood pressure.
    • Diabetes: Compared with white enrollees, Asian, Hispanic, and black enrollees were 6.9 percentage points, 5.6 percentage points, and 5.3 percentage points more likely to have diabetes, respectively, after adjusting for age and sex. Rates of undiagnosed diabetes were approximately 3 percentage points higher for Asian, Hispanic, and black than for white enrollees.
    • Obesity: 42.8 percent of enrollees were classified as obese. After adjusting for age and sex, black enrollees were 13.6 percentage points more likely to be obese than white enrollees, while Asian enrollees were 26.2 percentage points less likely to be obese than white enrollees.
  • Widespread variation in C-section birth rates across races reinforces persistent gaps in maternal health in the ESI market. Studies show that cesarean delivery can significantly reduce maternal morbidity and mortality in high-risk births. However, when performed in low-risk situations, cesarean section can increase the risk of infections and blood clots and can contribute to unnecessary postpartum complications, including death.

    • The analysis showed that 20.1%, 17.7%, and 17.0% of low-risk births among black, Asian, and Hispanic enrollees, respectively, were performed by cesarean section, compared with a rate of 13.6% among whites recorded.

    • After adjusting for age differences, black, Asian, and Hispanic participants with low-risk pregnancies were more likely to have a cesarean section than their white counterparts by 6.5, 3.9, and 3.4 percentage points, respectively.

  • Behavioral health and substance use problems were prevalent among all enrollees, but there were large differences in the severity of these problems and related outcomes for lesbian, gay, or bisexual enrollees.

    • Overall rates of anxiety and depression within the ESI were 13.3% and 14.1%, respectively. After adjusting for age and gender, white enrollees were more likely than black, Hispanic, and Asian enrollees to experience severe psychological distress by 2.0 percentage points, 1.8 percentage points, and 5.2 percentage points, respectively.

    • The percentage of lesbian, gay, or bisexual enrollees reporting serious psychological distress was 12.1 percentage points higher, anxiety rates were 16.6 percentage points higher, and depression rates were 18. 4 percentage points higher than straight enrollees after adjusting for age and sex.

    • 19.8 percent of enrollees used tobacco products (including smoking, cigarettes, chewing tobacco), 30.1 percent reported heavy alcohol use, and 18.8 percent used illegal drugs such as marijuana, cocaine, crack, heroin, abuse of painkillers, stimulants and tranquilizers to name a few. Heavy alcohol use was highest among Hispanics, while illicit drug use was highest among white enrollees.

  • Despite perceptions of the sustainability of coverage under ESI, enrollees face significant barriers to accessing care, particularly for those of racial/ethnic minority backgrounds and those 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 greatly by income.

    • Although nearly all enrollees (91.5 percent) reported having a usual source of care, the analysis showed significant differences in emergency department (ED) use—a proxy measure of access to care.

    • After adjusting for age and sex, black enrollees were 4.9 percentage points more likely than white enrollees to have visited the ED; in contrast, Asian enrollees were 4.5 percentage points less likely than white enrollees to have visited the ED.

    • After adjusting for age and sex, enrollees in the lowest income group (under $50,000) were 7.1 percentage points more likely than enrollees in the highest income group ($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 care reporting models and quality measures to mitigate any observed disparities. For example, our partnership with Kaiser Permanente will involve both companies jointly collecting and reporting health capital metrics for JPMorgan Chase employees in California with plans to introduce performance guarantees tied to health capital on certain quality measures beginning in 2023

To view the full report, click here. To view the Summary and FAQ, click here and here.

About Morgan Health

Morgan Health is a business unit of JPMorgan Chase focused on improving employer-sponsored health care. Through its investments and the advancement of accountable care, Morgan Health works to improve the quality, equity and affordability of employer-sponsored health care for JPMorgan Chase employees, their families and the US health care system. The business is led by Dan Mendelson, chief executive officer of Morgan Health, reporting to Peter Sher, vice chairman of JPMorgan Chase & Co. and a member of the company’s Operating Committee. Morgan Health is headquartered in Washington, DC. Visit morganhealth.com

For 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’ve studied nearly 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 needed to inform critical decisions facing society.

www.norc.org

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