Small Businesses Confront Health Care Disparities, New Index Reveals

A recent report by Vitable Health highlights a critical gap in healthcare experiences between small business employers and their employees. The findings from the inaugural Small Business Benefits Index reveal that while employers recognize the importance of healthcare benefits, employees face significant challenges in accessing care. This disparity, particularly regarding affordability, has repercussions for employee retention, productivity, and overall health outcomes.

Based on surveys of over 500 employers and 768 employees, the Index indicates that a substantial number of workers—specifically 40%—have postponed or skipped necessary medical care in the past year, with many citing cost as the primary barrier. This trend suggests that access to affordable healthcare is now nearly as influential as wages when individuals consider job opportunities. In fact, 70% of employees stated that affordable care significantly impacts their decision to remain in their current roles, and nearly 45% would prioritize reliable coverage over a modest hourly wage increase.

The report also underscores the financial implications of inadequate healthcare access. Employees reported losing nearly five full workdays each year due to absenteeism and working while unwell, reflecting the operational costs associated with delayed or forgone care.

Employer Perspectives versus Employee Realities

Interestingly, while nearly half of employers expressed confidence in their benefits, believing that employees consistently receive preventive care, the reality is starkly different. Only 66% of workers had an annual checkup in the past year, and just 30% completed recommended screenings. The report identifies high deductibles and unpredictable medical billing as significant deterrents for employees seeking routine care, even when they are insured.

Mental health access is another area of concern. Approximately 16% of employees reported that stress or mental health issues regularly affect their job performance, and nearly 20% indicated difficulties in obtaining support. Alarmingly, only 38% of employers offer any form of mental health benefits.

Opportunities for Change in Small Business Healthcare

The research suggests that small business owners are receptive to innovative care models, such as direct primary care and individual coverage Health Reimbursement Arrangements (HRAs). However, simplicity and measurable outcomes are essential for these changes to be effective. Respondents expressed that they would be most motivated by improvements in return-to-work times, enhanced preventive care utilization, and a reduction in visits to emergency rooms and urgent care facilities.

Joe Kitonga, founder and CEO of Vitable Health, emphasized that the findings illustrate the challenges small businesses encounter when navigating healthcare systems designed for larger employers. He advocates for meaningful reform that prioritizes access rather than just insurance coverage, suggesting that better outcomes for both employers and employees hinge on this focus.

The Index, conducted by YouGov, surveyed small business employers and employees across 15 industries between September and October 2025. As the landscape of small business healthcare continues to evolve, these insights highlight the pressing need for systemic improvements that can bridge the gap between employer expectations and employee realities.