Cost, not coverage, is the real barrier to workers accessing health care

PHILADELPHIA--(BUSINESS WIRE)--Vitable Health released its inaugural Small Business Benefits Index, revealing significant perception gaps between small business employers and employees on healthcare access and affordability.

Serving as an annual benchmark for understanding healthcare realities in small business America, this comprehensive survey of over 500 small business employers and 768 employees shows alignment on the importance of healthcare benefits, with both groups recognizing health coverage as essential to retention and productivity. However, the research reveals a stark divide between employer confidence and employee experience:

• 40% of small business employees skipped or postponed needed care in the past year, with 23% doing so multiple times
• 70% of workers say healthcare access influences whether they stay in a job, with nearly 45% choosing reliable coverage over a $0.50/hour raise
• Small businesses lose nearly one full workweek of productivity per employee annually due to health-related absenteeism and presenteeism

Health care access now rivals wages in retention decisions

The report reveals a fundamental shift in employee priorities, with healthcare benefits emerging as a retention lever as powerful as compensation. While 70% of employees say access to affordable healthcare influences whether they stay in their job, 44.7% would choose reliable healthcare coverage over a $0.50/hour pay increase. The productivity impact is equally significant: employees reported 2.8 missed workdays per year due to health issues plus an additional 2.2 days worked while ill, nearly five full workdays of lost productivity per employee each year.

The perception gap: Coverage doesn't always equal care

Despite meaningful investment in benefits, employer confidence often masks gaps in actual care utilization. While nearly half of employers (44.5%) are "very or extremely confident" their workforce receives preventive care, only 66.5% of employees had an annual checkup in the past year, and just 30.2% completed recommended screenings. The data reveals why: 62% of those who skipped care cited cost as the main reason, with high deductibles and unpredictable bills eroding confidence in traditional coverage models even among insured workers.

The report also identifies mental health access as a critical yet underaddressed challenge. While 16.3% of workers say stress or mental health issues "often" affect their work and 19.5% find mental health care difficult to access, only 37.6% of employers offer any mental health benefit.

Employers ready for innovation, but need simplicity

Despite these challenges, more than 40% of small business owners are likely to adopt alternative models such as direct primary care or ICHRA-based coverage. When asked what would convince them to invest in new models, employers prioritized faster return-to-work times (80.4%), higher preventive visit rates (76.1%), and reduced emergency room and urgent care visits (75.5%).

"Small business owners care deeply about their people, but the tools available to them were never designed for companies with ten, twenty, or fifty employees," said Joe Kitonga, Founder and CEO of Vitable Health. "This Index confirms what we see every day: coverage doesn't always equal care. It's time to rebuild healthcare from the ground up around access, not just insurance. Every worker deserves access to care they can afford. Every employer deserves a system that rewards prevention, not crisis."

To learn more, please visit www.vitablehealth.com

About the Report/Methodology

Vitable Health commissioned YouGov PLC to conduct a comprehensive survey of U.S. small business healthcare. The total sample included 510 small business employers (businesses with fewer than 250 employees) and 768 small business employees working full- or part-time across 15 industries. The surveys were fielded September-October 2025.