PHILADELPHIA, PA — A new report from Vitable Health reveals a widening gap between how small business employers view their healthcare benefits and how their employees actually experience care, with affordability emerging as a decisive factor in retention, productivity and long-term health outcomes.
The company’s first Small Business Benefits Index, based on responses from more than 500 employers and 768 employees, found broad agreement that healthcare coverage is essential. But the data highlight a significant divide between employer confidence and employee behavior: 40% of workers skipped or postponed needed medical care in the past year, and nearly a quarter did so multiple times. Most cited cost as the primary barrier.
The study shows healthcare access has become nearly as influential as wages in job decisions. Seventy percent of employees said access to affordable care affects their willingness to stay in a role, and almost 45% would choose reliable coverage over a 50-cent hourly raise. Workers also reported losing nearly five full workdays annually to absenteeism and working while sick, reflecting the operational cost of delayed or foregone care.
Employers reported strong confidence in their benefit offerings, with nearly half saying they believe employees consistently receive preventive care. But only two-thirds of workers had an annual checkup in the past year, and just 30% completed recommended screenings. High deductibles and unpredictable billing were cited as key reasons employees avoided routine care, even when insured.
Mental health access remains limited. About 16% of employees said stress or mental health issues regularly affect their job performance, and nearly 20% reported difficulty accessing support. Only 38% of employers offer any mental health benefit.
The research also shows small business owners are open to new care models, including direct primary care and individual coverage HRAs, but they want simplicity and measurable outcomes. Respondents said they would be most motivated by improvements in return-to-work times, higher preventive care utilization and fewer emergency room and urgent care visits.
Joe Kitonga, founder and CEO of Vitable Health, said the findings reflect the pressure small businesses face navigating systems built for much larger employers. He added that meaningful reform must focus on access, not just insurance, if employers and workers are to see better outcomes.
The Index was conducted by YouGov and surveyed small business employers and employees across 15 industries between September and October 2025.
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