Staying in a job for the health insurance? About 1 in 4 Americans do, a survey says

Why do some people stay in terrible, horrible, no good, very bad jobs?

A new report finds that nearly a quarter of workers who get health insurance through their jobs report staying in unwanted jobs for health insurance — a figure that's risen dramatically in the last five years.

The survey from West Health-Gallup Center on Healthcare in America finds that approximately 23 million adults are in what the report authors call "job lock." In 2021, 16% of those surveyed were in job lock.

"Anybody having to stay in a job just to keep their health insurance, knowing that they want to leave, is crazy," says Ellyn Maese, a research director for the center, a partnership between Gallup and West Health. "That is a concerning figure, even if it's 10%. But when we're seeing it rise to 1 in 4 employees, that's pretty serious."

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The numbers are higher for people who are ill. Of working adults with three or more chronic health conditions, the report found that 41% were staying in their jobs for health insurance.

This comes at a time when concerns about healthcare costs have been climbing. An April poll from the health research organization KFF found nearly two-thirds of adults are anxious about affording healthcare — tied for first with concerns about affording gas and transportation.

"Healthcare tops the list of economic worries right now," says Larry Levitt, executive vice president for health policy at KFF. "So it stands to reason that people would be concerned about leaving an unwanted job for fear of losing their health insurance."

Levitt was not involved in the new study from West Health-Gallup and says it fits with the picture KFF polls have found.

The findings from the survey released Wednesday may be compounded by pessimism about the job market, Maese says. A May Gallup poll found that just 28% of U.S. workers said it is a good time to find a job, the lowest it's been since 2013.

The economic effects

The consequences may extend beyond employees' discontent.

Unhappy employees are less effective, Maese explains, and that's bad for the U.S. economy at large. "Leaving, moving, becoming entrepreneurs," she says, is "what we need to see for our economy to really thrive."

To that end, recent changes in the Affordable Care Act may have been unhelpful. In 2021, Congress increased financial assistance to middle-income people buying their own insurance through the ACA marketplaces. When Congress let these subsidies expire in 2025, that help for would-be entrepreneurs evaporated. Levitt says the expiration of the ACA subsidies has contributed to increased costs and U.S. workers being stuck in jobs they might otherwise quit.

Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank, agrees this is a problem.

"Everyone acknowledges that job lock is real," he says.

"Whether the extent of job lock is 8%, 24%, or something else," Cannon says, "favoring employer-sponsored health insurance creates coverage gaps, reduces income mobility, and is crying out for reform."

Cannon would prefer insurance coverage that belongs to individuals rather than their jobs — insurance purchased by consumers that would be stable as they change jobs.

Maese is especially concerned about the middle class — workers who are "stuck in the middle, where they don't really qualify for assistance," she says, "but they also don't make enough to be able to catch up with the rising costs of healthcare."

A policy change, such as bringing back ACA subsidies, Maese says, is needed to course correct.

On the other hand, Cannon has long been a vocal critic of the ACA. He advocates for an efficient free market option that would "let consumers control their health insurance dollars and choose their own health plan." He's for expanding HSA options.

Yet both Maese and Cannon agree that reform is needed.

"For 100 years," Cannon says, "Congress has effectively penalized workers unless they enroll in health insurance that disappears when your job does."

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