Greater Washington Partnership Blueprint Report

Employer health coverage is foundational to affordability and accessibility of health and well-being services. Roughly 55% of employees across the Capital Region are covered by employer-sponsored health plans. However approximately 20% of employees at companies offering employer-sponsored healthcare are ineligible, often because they are part-time or temporary workers²⁷³—roles more commonly filled by Black and Hispanic workers.²⁷⁴ Employers are positioned to increase care accessibility for these individuals, either through direct eligibility in employer-sponsored plans or through annual subsidies to support securing coverage in the marketplace.

The need extends beyond just employer health coverage eligibility: the COVID-19 pandemic has underscored the need for reliable and accessible physical and mental health and well-being coverage. Over 50% of people report delaying care due to time constraints or transportation barriers²⁷⁵ and nearly half of employees say that mental health support is difficult to find or access;²⁷⁶ currently, only 32% of employees report that mental health services are covered by their insurance.²⁷⁷ Improvements in employee health and well-being benefits—and resulting health outcomes—can impact the bottom line by creating long-term cost savings, improved productivity, and increased employee satisfaction and retention.

Collecting and analyzing accurate race and ethnicity data is crucial to both understanding disparities in health outcomes and developing targeted interventions to promote equity. However, flaws in data collection and lack of transparency in reporting may foster or perpetuate mistrust. Historic efforts to standardize race, ethnicity, and language (REaL) data have not been comprehensive. Further, when collected, REaL data has not been used to drive equity, but rather has often harmed historically underserved populations through biased AI and race-based algorithms; these algorithms routinely deprive Black patients of necessary treatment, such as adjusting risk scores for race, leading to lower risk scores than white counterparts and delayed access to some types of care.²⁸¹

While sharing REaL data is optional for employees, businesses can foster trust with employees by encouraging self-reporting, being transparent with how data will be used, and normalizing data collection. Increased data sharing within the business community can help strengthen health equity; this may include working with insurers to pair REaL and health outcome data to predict and respond to health deficiencies or population health risks or creating a repository to inform an organization’s health equity strategy. When adopted broadly, improved data infrastructure and data management practices can drive the cross-sector agenda for health equity and support key performance indicator (KPI) measurement of existing interventions.

Washington D.C.’s maternal mortality rate is twice the national average²⁸⁹ and, across the U.S., mortality among Black mothers is twice as high as it is for other populations.²⁹⁰ In the U.S., for each pregnancy-related death there are 70 “near misses” resulting in severe maternal morbidity; these “near misses” are even more common among residents of low-income zip codes.²⁹¹ Furthermore, infants in our region also suffer disproportional outcomes: Richmond, Baltimore, and D.C. have higher annual rates of low birth- weight newborns (11.9%, 11.0%, and 10.0% respectively) than the national average of 8.2%.²⁹² This is higher in predominantly Black neighborhoods—in D.C.’s Ward 8 the rate increases to over 14.4%.²⁹²

Several interventions that can be offered via employer benefits or subsidies have shown to improve maternal and infant outcomes, namely home visiting programs,^EE the use of doulas,^FF and expanded postpartum services.^GG Within postpartum care, screening and providing support for perinatal mood and anxiety disorders (PMADs) is particularly important for supporting maternal recovery, maternal transitions back into the workplace, and reducing the overall cost of perinatal care. PMADs cost an average of $32,000 per mother affected without treatment.²⁹³ By providing coverage for additional maternal health services, employers empower caregivers to access holistic care, enhance their preparation for parenthood, and support maternal mental health prior to and during their return to work.

Babies of mothers who do not get prenatal care are five times more likely to die and three times more likely to have a low birthweight,³⁰⁰ and mothers without prenatal care are five times more likely to die during pregnancy than those who receive prenatal care.³⁰¹ Health screenings play a vital role in the early identification and treatment of issues associated with adverse maternal and infant health outcomes. The underutilization of health screenings and services can negatively impact progress toward improving maternal and infant health outcomes (e.g., infant and maternal mortality, low birthweight, preterm birth).

Despite the benefits of screenings, 26% of women report needing additional time off for prenatal visits, but not asking their employer due to fear of repercussions.³⁰¹ Health services for mothers and infants account for one-fifth of large employers’ medical spend, with higher costs for mothers who do not have early prenatal care (on average $1,000 higher hospital costs).²⁰³ The business community is positioned to address the key barriers that prevent their employees from accessing these services and to tailor policies and incentives to mitigate logistical barriers, enhance workplace culture, and remove stigma.

In the Capital Region, between 60% and 80% of residents do not live within a half mile of a grocery store, compared with 50% of the U.S. population.³ Lack of access to healthy food in under-resourced communities is often a result of systemic prioritization of food supply investments to wealthy communities, creating structural barriers to food and nutrition security. In Baltimore City, 1 in 4 people are food insecure.³¹²

Individuals living in food deserts have a higher risk of obesity and chronic disease due to lack of consistent access to nutritious food.³¹³ Food insecurity also effects employers: loss of productivity from inconsistent nutrition results in an estimated $5.48B annual loss to the U.S. economy³¹⁴ and food-insecure^HH employees see an estimated additional $1,863 in medical costs annually.³¹⁵

While there are existing resources available for food-insecure families, some of the main challenges are centered on accessibility— for both families trying to navigate resources and hunger-relief organizations attempting to secure food. Businesses can directly invest in local food ecosystems by partnering with existing food assistance programs to expand capacity and scale impact (e.g., through funding, providing free space, professional services, etc.). Furthermore, employers can support food access by lending expertise to help develop or refine food systems technology—including software and registration systems. These solutions c an reduce barriers to accessing food or registering for food benefits.

Supplemental Nutrition Assistance Program (SNAP) Enrollment:
In Virginia, only 72% of eligible SNAP recipients are enrolled in the program (compared with the national average of 82%).
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SNAP-eligible individuals commonly report a lack of computer access and difficulty navigating the application as barriers to enrollment
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Public food benefits are critical interventions that are proven to help lift people out of poverty.³²⁰ Research shows that food benefits are highly effective at reducing food insecurity and, for low-income children receiving benefits, food benefits improve long-term health, academic performance, educational attainment, and economic self-sufficiency.³¹⁹

Food insecurity is a significantly larger challenge for underrepresented communities—Black residents are 93-187% more likely to be eligible for and receive SNAP assistance than white residents
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Even with the October 2021 increase to SNAP benefits, there is still a gap between the provided per meal allocation and the cost of a moderately-priced meal in the Capital Region—ranging from 11% in Richmond and Baltimore to 26% in D.C.³²⁰ Furthermore, key population groups are ineligible to receive benefits or can only receive benefitsII for a limited period of time, including most students,³²¹ unemployed adults without minor children,³²² and in Maryland, individuals with former drug convictions.³²³ Yet, these populations demonstrate high levels of need—roughly 1 in 3 university students³²⁴ and 91% of recently released felons³²⁵ are food insecure.

Research suggests that nationally 1 in 9 full-time workers may live in poverty.³²⁶ Increased funding and expanded eligibility can scale the impact of public food benefits, further alleviating food insecurity and closing the benefits gap for historically ineligible individuals. Businesses can engage in coordinated advocacy to support expanded eligibility and financing of food benefits to improve food security—and thereby productivity and health outcomes—for their employees and community.