Small Business Healthcare Gap Threatens Employee Well-being

A recent report from Vitable Health has revealed a troubling disconnect between small business employers’ perceptions of healthcare benefits and their employees’ experiences with care. The inaugural Small Business Benefits Index, based on insights from over 500 employers and 768 employees, highlights affordability as a critical factor influencing retention, productivity, and long-term health outcomes.

The findings indicate a significant gap between employer confidence and employee behavior regarding healthcare access. While a consensus exists on the importance of healthcare coverage, approximately 40% of employees reported skipping or delaying necessary medical care in the past year, with nearly 25% doing so multiple times. Cost emerged as the primary barrier for these individuals, emphasizing that access to affordable care is nearly as influential as wages in job decision-making. In fact, 70% of employees stated that the availability of affordable healthcare impacts their willingness to remain with a company, while almost 45% would prioritize reliable coverage over a 50-cent hourly raise.

The study also revealed the operational cost of inadequate care, with workers losing nearly five full workdays annually due to absenteeism or working while sick. This underscores the profound impact that delayed or forgone medical care has on both employee well-being and business productivity.

Employer Confidence vs. Employee Experience

Despite employers exhibiting strong confidence in their benefits offerings—nearly half believing that employees consistently receive preventive care—actual employee experiences tell a different story. Only 66% of workers had an annual check-up in the past year, and merely 30%16% of employees reported that stress or mental health issues regularly impact their job performance. Nearly 20% of respondents indicated difficulties in accessing mental health support, with only 38% of employers providing any mental health benefits.

Seeking New Solutions in Healthcare

The research suggests that small business owners are receptive to innovative care models, including direct primary care and individual coverage Health Reimbursement Arrangements (HRAs). However, they prioritize simplicity and measurable outcomes. Employers expressed a desire for improvements in return-to-work times, higher utilization of preventive care, and fewer emergency room visits.

Joe Kitonga, founder and CEO of Vitable Health, stated that these findings reflect the unique pressures small businesses face within healthcare systems designed for larger employers. He emphasized that significant reform must focus on improving access rather than just providing insurance, to ensure better health outcomes for both employers and employees.

The Small Business Benefits Index was conducted by YouGov and surveyed small business employers and employees across 15 industries from September to October 2025. As the landscape of small business healthcare continues to evolve, addressing the existing gaps in employee access to care will be vital for fostering a healthier workforce and enhancing overall productivity.