Racial and Socioeconomic Disparities: Ignoring Inequitable Benefit Design Is Not an Option


In a new commentary published in BenefitsPro, Kimberly Westrich, NPC Vice President for Health Services Research, and Bruce Sherman, MD, medical advisor for the National Alliance of Healthcare Purchaser Coalitions, encourage employers to expand their diversity, equity and inclusion (DEI) practices to ensure that all low-wage workers have affordable access to health care. Low-wage workers often have the highest prevalence of chronic conditions yet are least able to afford health care. Further exacerbating inequality, minorities and people of color constitute a disproportionate share of low-wage workers.

The authors point out that many employers offer plans where premiums and deductibles are the same for all workers, no matter their wage level. The commentary states that this "one-size-fits-all" approach can create inequity in health care because lower-wage workers may have difficulty affording the high co-payments and deductibles that have become increasingly prevalent. As a result, many low-wage workers avoid or delay seeing their doctors.

Ms. Westrich and Dr. Sherman recommend that employers re-evaluate and change their benefit design plans. Employers can improve their DEI practices by considering these questions:

  • Do low-wage workers have equitable plan design options that include premium and/or health savings account (HSA) contribution subsidies?
  • Are there differences in the use of preventive care services by enrollees in different wage categories
  • Are there disparities in medication use among individuals in different wage groups that may reflect affordability concerns?
  • Are there opportunities to educate enrollees to select the most cost-effective plan given their health care utilization patterns and income?

The authors suggest that employers look at their health care data – including claims, disability, family medical leave and wellness programs – to evaluate the differences in use by wage category. Employers can conduct focus group discussions with employees to get a better understanding of their health needs as well as the barriers that stand in the way of addressing those needs.
In addition, employers can also improve coverage affordability for low-wage workers by providing premium subsidies or wage-based health savings account contributions, offering pre-deductible coverage of medications for chronic conditions, and eliminating the use of copay accumulator adjustment programs. Please read the authors' full comments on the BenefitsPro website