Small Businesses Confront Healthcare Gap, New Index Reveals

A recent report from Vitable Health reveals a troubling disparity between small business employers’ perceptions of healthcare benefits and their employees’ experiences. The inaugural Small Business Benefits Index, which surveyed over 500 employers and 768 employees, highlights affordability as a critical factor affecting retention, productivity, and long-term health outcomes.

While there is a general consensus among employers that healthcare coverage is essential, the findings indicate significant gaps in understanding employee behavior. Notably, 40% of workers reported postponing or skipping necessary medical care in the past year, with cost being the primary barrier. This lack of access to care is influencing job decisions, as 70% of employees stated that affordable healthcare impacts their willingness to remain in their roles. In fact, nearly 45% would opt for reliable coverage over a modest pay increase of 50 cents per hour.

The financial implications of delayed care are substantial. Workers indicated they lose nearly five full workdays each year due to absenteeism or working while sick, underscoring the operational costs linked to inadequate healthcare access.

Employer Confidence vs. Employee Reality

Employers displayed strong confidence in their benefit offerings, with almost half believing that employees consistently receive preventive care. However, only two-thirds of workers reported having an annual checkup in the past year, and a mere 30% completed recommended screenings. High deductibles and unpredictable billing practices were identified as significant deterrents to accessing routine care, even among those with insurance.

Mental health access remains another area of concern. Approximately 16% of employees stated that stress or mental health challenges frequently affect their job performance, while nearly 20% faced difficulties in obtaining support. Alarmingly, only 38% of employers provide any mental health benefits, leaving many workers without necessary resources.

Seeking Solutions for Small Businesses

The research indicates that small business owners are receptive to new healthcare models, such as direct primary care and individual coverage health reimbursement arrangements (HRAs). However, they emphasize the need for simplicity and measurable outcomes. Respondents cited improvements in return-to-work times, increased preventive care utilization, and fewer emergency room visits as key motivators for adopting new care models.

Joe Kitonga, founder and CEO of Vitable Health, stated that the findings reflect the challenges small businesses encounter when navigating a healthcare system designed for larger employers. He emphasized that meaningful reform must prioritize access to care rather than merely focusing on insurance coverage.

The Small Business Benefits Index was conducted by YouGov, surveying small business employers and employees across 15 industries from September to October 2025. As the healthcare landscape continues to evolve, addressing these gaps will be crucial for supporting the health and productivity of small business employees.