Washington D.C. – March 5, 2026 – A comprehensive survey released today by the Employee Benefit Research Institute (EBRI) reveals a complex landscape of health insurance coverage in the United States, highlighting significant concerns about affordability that impact both immediate access to medical care and long-term financial well-being for American adults. The findings underscore persistent challenges in the employer-sponsored insurance market and growing anxieties surrounding the cost and coverage of emerging, high-priced medications.
The EBRI report, based on a survey of over 2,000 adults conducted in late 2025, indicates that a majority of working-age Americans continue to rely on their employers for health insurance. Specifically, six in 10 adults reported having employment-based insurance coverage, a statistic that has remained relatively stable over recent years, suggesting a foundational reliance on this system. However, beneath this seemingly consistent surface lies a growing vulnerability for many, particularly those employed by smaller businesses.
Rising Costs Threaten Employer-Sponsored Coverage
While the overall share of employers offering health coverage saw a slight uptick in 2024, this growth was almost exclusively driven by large employers. In stark contrast, companies with fewer than 100 employees experienced a decline in their sponsorship of health insurance plans. This trend, documented in a separate EBRI report from January 2026, points to a widening disparity in access to benefits based on company size. Smaller businesses, often operating with tighter margins, appear to be struggling more acutely with the escalating costs of providing health insurance, potentially leaving a significant portion of the workforce at risk of losing their coverage or facing substantially higher out-of-pocket expenses.
The implications of this trend are profound. For individuals employed by small businesses, the loss of employer-sponsored insurance can create a precarious situation. They may be forced to seek coverage through the individual market, which can be significantly more expensive and offer less comprehensive benefits, or they may go uninsured altogether. This not only jeopardizes their ability to access necessary medical care but also exposes them to the devastating financial consequences of unexpected health events.
The Looming "Healthcare Affordability Crunch"
Industry analysts have been anticipating this growing pressure on healthcare costs for some time. In November 2025, Mercer, a global consulting firm specializing in human resources and benefits, predicted a forthcoming "healthcare affordability crunch" for both employers and their employees. Mercer’s analysis attributed a significant portion of these rising costs to the increasing expenditure on prescription drugs. Among the most notable drivers of this surge is the widespread adoption and demand for GLP-1 receptor agonist medications, commonly used for weight management and diabetes treatment.
These newer, highly effective medications, while offering significant health benefits for many, come with a substantial price tag. The cost of a single prescription can run into hundreds or even thousands of dollars per month, placing immense pressure on insurance plans and individual budgets. As these drugs become more prevalent, their impact on overall healthcare spending is becoming increasingly undeniable, forcing insurers and employers to re-evaluate their coverage strategies and cost-sharing arrangements.
Navigating the Complexities of GLP-1 Coverage
The EBRI survey also delved into the specific issue of coverage for GLP-1 medications, revealing a significant gap between patient desire for coverage and the reality of what insurance plans provide. The vast majority of surveyed adults who expressed an opinion believed that GLP-1s should be covered by insurance. However, a notable percentage, approximately half of those surveyed, were uncertain whether their current health plan offered such coverage. This uncertainty breeds anxiety and can lead to delayed or forgone treatment, even when a medication is medically indicated.
Furthermore, even among plans that do offer some level of coverage for GLP-1s, the scope of that coverage varies widely. Respondents reported that some plans only covered these medications when prescribed for diabetes, while others restricted coverage to obesity treatment. A smaller subset of plans provided coverage for both conditions. This patchwork of coverage creates a complex and often frustrating experience for patients and their healthcare providers, who must navigate differing eligibility criteria and reimbursement policies, adding another layer of complexity to an already challenging healthcare system.
The Financial Fallout of Unmet Medication Needs
The financial burden associated with GLP-1 medications has led to difficult decisions for many patients. The EBRI survey found that roughly one-third of individuals taking a GLP-1 medication had stopped using it. When asked for their reasons, cost emerged as the primary barrier, cited by four in 10 respondents. This indicates that the high price of these drugs is a significant deterrent, preventing many from accessing a treatment that could improve their health outcomes.
An additional one in seven respondents who discontinued their GLP-1 medication pointed to a lack of coverage for the drug as the contributing factor. This statistic directly links insurance benefit design to patient adherence and ultimately, to their health status. When essential medications are not adequately covered, patients are forced to make impossible choices between their financial stability and their physical well-being. This situation highlights a critical area where the healthcare system is failing to meet the needs of a significant segment of the population.
Broader Implications for Financial Security
The challenges surrounding healthcare affordability extend beyond the immediate access to medical services and prescription drugs. They have a direct and significant impact on the longer-term financial security of individuals and families. High healthcare costs can deplete savings, lead to increased debt, and hinder the ability to save for other critical life goals, such as retirement, education, or homeownership.
For individuals facing chronic conditions or the need for ongoing medical treatment, the persistent burden of high deductibles, co-pays, and uncovered services can create a cycle of financial instability. This is particularly true for those who experience unexpected medical emergencies. The fear of catastrophic medical debt remains a pervasive concern for many Americans, and the current trajectory of healthcare costs only exacerbates this anxiety.
The Role of Policy and Employer Strategy
The findings from EBRI underscore the critical need for a multi-faceted approach to address healthcare affordability. This includes exploring policy interventions that can help control the rising cost of prescription drugs, such as negotiating drug prices or exploring alternative pricing models. It also involves incentivizing employers, particularly small businesses, to continue offering robust health insurance benefits.
Furthermore, employers themselves are at a critical juncture. As they grapple with increasing premiums and benefit costs, they must weigh the short-term financial savings against the long-term impact on employee health, productivity, and financial well-being. Innovative benefit design, including exploring carve-out options for high-cost specialty drugs or partnering with pharmacy benefit managers (PBMs) to negotiate better pricing, may become increasingly crucial.
Future Outlook and Recommendations
The EBRI report serves as a stark reminder that while employment-based insurance remains the primary source of coverage for many Americans, its effectiveness is increasingly being challenged by affordability concerns. The widening gap in coverage sponsorship between large and small employers, coupled with the soaring costs of innovative treatments, necessitates urgent attention from policymakers, employers, and healthcare providers.
Moving forward, a concerted effort will be required to ensure that health insurance not only provides access to care but also contributes to the long-term financial security of all Americans. This will likely involve a combination of legislative action, employer-led benefit innovation, and continued research to understand and address the evolving dynamics of the healthcare landscape. The pursuit of accessible and affordable healthcare remains a paramount challenge for the nation, with significant implications for individual prosperity and the overall economic health of the country. The insights gleaned from this EBRI report will undoubtedly inform ongoing discussions and shape future strategies aimed at building a more equitable and sustainable healthcare system.
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