The Hidden Struggle – How Employers and Employees Are Both Losing with Healthcare Costs.

Healthcare in America is a significant burden for both employers and employees. Employers invest billions of dollars annually to provide their workforce with health insurance, but many employees still face unaffordable copays and deductibles. The result? People are forced to choose between receiving essential medical care and paying their bills, all while employers continue to absorb skyrocketing healthcare costs.

This issue is particularly painful for lower-income workers who, despite having insurance, are one emergency or prescription away from financial hardship. In this newsletter, we’ll explore real-life examples of this broken system and discuss why the current approach to healthcare needs to change.

The Employer’s Perspective: Paying for a Costly System That Fails

Employers across the U.S. spend enormous amounts of money to provide health insurance as part of their benefits packages. In fact, the average employer-provided health insurance premium for family coverage is over $22,000 per year. This investment is meant to ensure that employees have access to care, but the truth is, even with this heavy financial burden, many employees are still struggling to afford their healthcare.

Example: Allyssa works at a mid-sized company that offers health insurance as part of its benefits package. While her employer pays a large portion of her premium, Allyssa’s family still faces copays for every doctor's visit, prescription, or specialist referral. When her son needed to see a specialist for chronic ear infections, the $50 copay each visit began to add up—making it difficult for Allyssa, who already struggles to cover rent and utility bills, to justify taking him for follow-up appointments.

For companies, this system doesn’t just hurt employees like Allyssa. It also leads to higher rates of absenteeism, lower productivity, and dissatisfied workers who may feel trapped in a cycle where healthcare coverage is more of a financial liability than a benefit.

The Employee’s Reality: Insurance Doesn’t Always Mean Affordable Care

While having health insurance is essential, for many workers, it doesn’t always mean they can afford the actual care. High deductibles, copays, and out-of-pocket expenses are often so burdensome that employees are forced to delay or skip necessary medical treatments.

Real-life Example: Brian is a warehouse worker making $38,000 a year. He has health insurance through his employer, but after paying his $400 monthly premium, plus rent, utilities, groceries, and transportation costs, he struggles to make ends meet. A recent health scare sent him to the ER, resulting in a $2,500 hospital bill, despite his insurance coverage. Brian now faces a dilemma: pay his healthcare bills or keep the lights on. His insurance plan requires a $75 copay for each follow-up visit, a cost he simply can’t afford right now.

For people like Brian, the healthcare system feels broken. Even though he has insurance, the high out-of-pocket costs leave him feeling financially insecure and worried about his family’s future. As his employer, how can you ensure your workers are actually getting the care they need if they’re afraid of the financial implications of a doctor’s visit?

The Ripple Effect: Healthcare Costs and Worker Well-Being

Employees who can’t afford healthcare costs are more likely to forgo necessary treatments, which can lead to worse health outcomes down the road. Skipping routine doctor visits or delaying prescriptions can result in more severe health issues that are expensive to treat. In the long term, this also leads to increased absenteeism and reduced productivity.

Case in Point: Let’s consider Madalyn, who works full-time as a customer service representative. After dealing with chronic migraines, she was prescribed medication to manage her condition. However, the monthly copay of $60 for her medication made it too expensive to continue after she paid her rent and childcare fees. Without the medication, Madalyn's migraines became more frequent, resulting in missed workdays. This put her at risk of losing her job and further destabilized her financial situation.

Madalyn's case is not unique. The consequences of high healthcare costs aren’t just personal—they extend into the workplace. When employees can’t get the care they need, it affects their ability to work, leading to increased turnover and decreased morale.

The Need for Change: Reducing the Burden on Employees and Employers

The current healthcare system especially when it comes to private insurance, creates an unfair dynamic where both employers and employees bear the financial burden, yet neither side gets real value from the system. Employers are paying massive sums to provide health insurance, but their workers still struggle to access affordable care. The system, as it stands, is failing both sides.

Employers can take action by exploring alternative healthcare models such as:

• Telehealth services to reduce the cost of routine visits.
• Health savings accounts (HSAs) with employer contributions to help employees cover out-of-pocket costs.
• On-site clinics or partnerships with local healthcare providers for more affordable care.
• Wellness programs aimed at preventive care to reduce the overall need for expensive treatments.

Ultimately, systemic change is necessary. We need to rethink how healthcare is delivered and financed in the U.S., so that having health insurance actually means affordable healthcare for all employees, not just coverage on paper.

The Healthcare Dilemma

Employers are pouring money into a system that’s leaving their employees vulnerable, while workers are struggling under the weight of high deductibles and copays. This imbalance must be addressed if we are to have a healthcare system that works for everyone. It’s time for employers, policymakers, and healthcare providers to come together and find sustainable solutions that will ensure affordable care and reduce the burden on both sides.

As employers continue to invest in their employees’ well-being, the ultimate goal should be ensuring that healthcare is accessible and affordable for all, without putting anyone’s financial security at risk.

Thank you for reading, and I hope you will subscribe to BioSync for more content related to healthcare in the fields of AI, Web3, and ethics.

Meagan Clarkson