Vitable Health’s 2025 Small Business Benefits Index Exposes Growing Divide Between Employer Confidence and Employee Healthcare Reality
Vitable Health, an all-in-one health benefits platform reshaping access to affordable healthcare for the American workforce, has released its inaugural 2025 Small Business Benefits Index, offering one of the most comprehensive examinations to date of how small businesses perceive—and provide—healthcare in comparison to how employees actually experience it. The findings highlight a widening disconnect: while employers overwhelmingly believe they are offering meaningful healthcare support, employees report substantial financial and logistical barriers that prevent them from getting the care they need.
Drawing data from more than 500 small business employers and 768 employees across the United States, the Index serves as an annual benchmark designed to capture the state of healthcare access, affordability, and impact within small business workplaces. Employers and employees agree on one point: healthcare matters. Both groups identified strong benefits as essential to retention, wellbeing, and productivity. But beneath this shared belief lies a critical tension—workers increasingly cannot afford to use the healthcare benefits they technically have.
Affordability Takes Center Stage: 40% of Workers Delayed or Forgo Needed Care
One of the most striking findings from the Index is the prevalence of skipped or delayed medical care. Four in ten small business employees postponed or avoided necessary care within the past year, and nearly one in four did so multiple times. Although small businesses often provide some form of coverage, rising costs—especially high deductibles and unpredictable out-of-pocket expenses—make many employees reluctant or unable to seek routine or even urgent care.
The problem is not simply about insurance status. The report shows that 62% of workers who skipped care cited cost as the primary reason. Even insured employees expressed uncertainty and fear about surprise bills, unpredictable copays, and the burden of meeting large deductibles before their insurance coverage provides meaningful financial relief. This disconnect between offering insurance and providing access to practical, usable healthcare sits at the heart of Vitable’s findings: coverage does not automatically equal care.
Healthcare Access Becomes a Key Factor in Workforce Retention
The Index identifies a major shift in workforce priorities: healthcare access now holds nearly the same weight as wages in retention decisions. Seventy percent of employees surveyed said access to affordable healthcare affects whether they stay at their current job. Even more revealing, 44.7% would choose reliable health coverage over a $0.50 per hour raise, suggesting that stability and predictability in healthcare have become as valuable as direct compensation.
This insight comes at a time when small businesses already struggle with labor shortages, high turnover, and rising recruitment costs. With healthcare access emerging as a top driver of job satisfaction and retention, small business owners are increasingly recognizing that traditional insurance offerings—expensive, complex, and often underutilized—may not meet the expectations or needs of today’s workforce.
The Productivity Toll: Nearly One Workweek Lost Per Employee Each Year
In addition to retention challenges, the Index highlights a substantial productivity loss linked to inadequate healthcare access. Employees reported an average of 2.8 missed workdays annually due to health issues, plus 2.2 days of “presenteeism”—working while sick, which often results in lower productivity and increased risk of spreading illness in workplace settings.
Combined, this results in nearly five full workdays of productivity lost per employee per year. For small businesses, where every worker often carries significant operational weight, this translates to costly but preventable disruptions. Improved access to affordable and timely care—including primary care, preventive services, and mental health support—has the potential to reclaim substantial value for employers.
Employer Confidence vs. Employee Reality: A Misaligned Picture of Preventive Care
While employees struggle with affordability and access, many employers believe their workers are successfully using the benefits provided. Nearly 44.5% of employers reported feeling “very or extremely confident” that their workforce is receiving regular preventive care. However, the employee data tells a different story:
- Only 66.5% completed an annual checkup in the past year
- Just 30.2% underwent recommended preventive screenings
- Major reasons cited for skipped care included cost, scheduling challenges, and lack of clarity about covered services
This gap indicates that employers may be overestimating the effectiveness of their benefits packages and underestimating the financial strain employees face when attempting to utilize them.
Mental Health Needs Are Rising—But Remain Under-Supported
The Index also sheds light on a rapidly growing yet insufficiently addressed area: mental health. According to survey responses:
- 16.3% of workers say mental health issues or stress “often” impact their ability to work effectively
- 19.5% report difficulty accessing mental health services
- Yet only 37.6% of employers offer any form of mental health benefit
The rise in mental health needs, combined with limited availability of employer-sponsored resources, highlights a significant opportunity for small businesses to strengthen wellbeing support—and reduce productivity losses linked to stress, burnout, and anxiety.
Small Businesses Show Openness to Innovation—But Need Simplicity and Value
Despite the challenges documented in the Index, the findings also reveal an encouraging trend: more than 40% of small business owners are considering or are likely to adopt alternative healthcare models. These include:
- Direct primary care
- Innovative employer-funded care models
- Individual Coverage HRAs (ICHRAs)
- Hybrid benefits platforms that emphasize accessibility and affordability
When asked what would persuade them to invest in new healthcare approaches, employers prioritized measurable outcomes:
- 80.4% want faster return-to-work rates
- 76.1% want increased preventive care utilization
- 75.5% want reductions in emergency room and urgent care visits
These priorities indicate that employers are not simply looking for cheaper benefits—they’re looking for solutions that deliver real, quantifiable value to both their employees and their business operations.
A Call for a New Healthcare Model Prioritizing Access Over Insurance
Reflecting on the findings, Joe Kitonga, Founder and CEO of Vitable Health, emphasized the need to fundamentally rethink healthcare for small businesses.
“Small business owners care deeply about their people, but the tools available to them were never designed for companies with ten, twenty, or fifty employees,” Kitonga said. “This Index confirms what we see every day: coverage doesn’t always equal care. It’s time to rebuild healthcare from the ground up around access, not just insurance. Every worker deserves affordable care. Every employer deserves a system that rewards prevention, not crisis.”
About the Report/Methodology
Vitable Health commissioned YouGov PLC to conduct a comprehensive survey of U.S. small business healthcare. The total sample included 510 small business employers (businesses with fewer than 250 employees) and 768 small business employees working full- or part-time across 15 industries. The surveys were fielded September-October 2025.
About Vitable Health
Vitable Health is the nation’s leading health benefits platform, making healthcare better for business owners and employees. With a focus on real access over red tape, Vitable Health offers employers affordable, ACA-compliant health benefit solutions, including Minimum Essential Coverage (MEC) plans, MVP plans, and ICHRA and QSEHRA options, that are packaged with Direct Primary Care and can be enhanced with Vision and Dental benefits. Every plan includes access to virtual primary care visits, mental health coaching, and over 1,000 covered prescriptions and labs with zero out-of-pocket costs. To date, Vitable Health has raised $25 million from top-tier investors, including First Round Capital, Y Combinator, Cherryrock Capital, Citi Bank’s Impact Fund, Commerce Ventures, Jack Altman, Michael Seibel, Immad Akhund, and SoftBank Opportunity Fund.
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