\u201cA lot of times, health care comes with a job.\u201d<\/p>\n
Sen. John Thune (R-S.D.), in an interview with KOTA on May 30, 2025<\/p>\n
Millions of people are expected<\/a> to lose access to Medicaid and Affordable Care Act marketplace health insurance plans if federal lawmakers approve the One Big Beautiful Bill Act, President Donald Trump\u2019s domestic policy package, which is now moving through the Senate.<\/p>\n Senate Majority Leader John Thune discussed health care and the pending legislation in an interview with KOTA<\/a>, a South Dakota TV station. But he focused on a different kind of health insurance \u2014 employer-sponsored insurance.<\/p>\n \u201cA lot of times, health care comes with a job,\u201d Thune said.<\/p>\n Thune\u2019s comments in the interview were made in the context of highlighting part of the GOP\u2019s economic policy objective. \u201cCreating those better-paying jobs that come with benefits is ultimately the goal here,\u201d he said.<\/p>\n KFF Health News reached out to Thune\u2019s office to find out the basis for this comment. His communications director, Ryan Wrasse, responded by reiterating Thune\u2019s message: \u201cGetting a job has the potential to lead a worker to acquiring health care.\u201d<\/p>\n Paul Fronstin, director of health benefits research at the Employee Benefit Research Institute, said Thune\u2019s comment may also be alluding to discussions surrounding Medicaid work requirements. The One Big Beautiful Bill Act would let nondisabled adults<\/a> enroll in Medicaid only if they prove they\u2019re volunteering, working, or searching or training for work.<\/p>\n Medicaid, funded by the federal government and states, is the country\u2019s main health insurance program for people with low incomes. Some people with disabilities also qualify.<\/p>\n Some Republicans have built on the jobs talking point in defending the Medicaid cuts and work requirements. Sen. James Lankford (R-Okla.), for instance, told CNBC<\/a> the bill isn\u2019t about \u201ckicking people off Medicaid. It\u2019s transitioning from Medicaid to employer-provided health care.\u201d<\/p>\n But the health policy experts we checked with made clear that getting a job isn\u2019t a guarantee for getting work-sponsored insurance.<\/p>\n Employer-Sponsored Health Insurance: The Basics<\/strong><\/p>\n These experts said most jobs do offer health insurance. But they also said the link between employment and work-based coverage is not always straightforward.<\/p>\n \u201cWhen I see this statement, I\u2019m like, \u2018I\u2019ve got so much more to say about this.\u2019 But I\u2019m not arguing with the statement,\u201d Fronstin said.<\/p>\n Matthew Rae, an associate director focused on researching private insurance at KFF, a health information nonprofit that includes KFF Health News, also weighed in.<\/p>\n \u201cEmployer-sponsored coverage remains the bedrock of how people get health insurance in the United States,\u201d Rae said. \u201cI would say that getting a job is not a guarantee you\u2019re going to have health insurance. It just increases your chances of getting it.\u201d<\/p>\n About 60% of Americans younger than 65 receive health insurance through their job or as the spouse, child, or other dependent of someone insured through their work, according to 2023 KFF data.<\/a><\/p>\n Among workers ages 18 to 64 who were eligible but didn\u2019t sign up for their workplace insurance, 28% said the reason they decided not to enroll was that the plans were too expensive, 2023 KFF data<\/a> showed.<\/p>\n Most of these workers found health insurance elsewhere, such as through a relative\u2019s workplace plan. But a small percentage of eligible employees, 3.7%, were uninsured<\/a>.<\/p>\n Health insurance has been \u201cthe most valued benefit in the workplace\u201d since businesses began offering it<\/a> to recruit employees in a tight labor market during World War II, Fronstin said.<\/p>\n Federal law also encourages companies to offer plans. Under the Affordable Care Act, employers with 50 or more full-time workers are penalized<\/a> if they don\u2019t offer most employees insurance that the federal government considers affordable.<\/p>\n As of last year, 54% of companies offered health insurance to at least some employees, according to KFF<\/a>.<\/p>\n But that\u2019s not the main way the ACA helped lower the rate<\/a> of people without health insurance, said Melissa Thomasson, a professor at Miami University in Ohio who specializes in the economic history of health insurance. \u201cNearly all of that\u201d change, she said, came from the ACA creating private marketplace plans and allowing states to expand Medicaid eligibility.<\/p>\n Health policy analysts<\/a> say the One Big Beautiful Bill would make it more difficult for people to qualify or afford marketplace plans, with proposals that would increase paperwork, shorten enrollment periods, and allow enhanced tax credits to fizzle out. Thomasson also noted that political rhetoric surrounding jobs and health insurance doesn\u2019t always align.<\/p>\n \u201cWe often talk about small businesses being the engine of job creation,\u201d but those are the businesses that often can\u2019t afford to offer workplace insurance, she said.<\/p>\n So Who Isn\u2019t Insured Through Workplace Insurance?<\/strong><\/p>\n The most obvious category of people who don\u2019t have workplace insurance are those who don\u2019t have a job. This group includes children and retirees, people searching for work, people who choose not to work, and those who can\u2019t work, because of a disability or illness.<\/p>\n Another group without employer-provided insurance is the 25% of people ages 18 to 64 who have a job but are unable to obtain such insurance, according to 2023 data from KFF<\/a>.<\/p>\n Some of these people work for companies that don\u2019t offer health insurance. These employers tend to be small businesses or part of certain industries, such as farming and construction.<\/p>\n Others are part-time, temporary, or seasonal workers at companies that offer health insurance only to full-time employees. Workers with low incomes are significantly less likely than those with higher incomes to be eligible for workplace insurance, according to 2023 KFF data.<\/a><\/p>\n People who aren\u2019t employed or don\u2019t get insurance through their job can get coverage in other ways. Some are insured through a relative\u2019s workplace plan, while others purchase plans and may qualify for subsidies on the ACA marketplace.<\/p>\n Others get insurance through Medicaid or Medicare, the federal health insurance program for people 65 or older and some people with disabilities.<\/p>\n Cost and Quality \u2014 And Therefore Access to Care \u2014 Vary<\/strong><\/p>\n Just because someone has health insurance doesn\u2019t mean they\u2019ll get the health care they need. People may skip or delay care if their plans are unaffordable or if they limit in-network providers.<\/p>\n \u201cHealth benefits come in all shapes and sizes,\u201d Fronstin said. \u201cSome employers offer very generous benefits, and others less so.\u201d<\/p>\n KFF data shows that premiums and enrollees\u2019 cost-sharing expenses grew faster than wages from 2008 to 2018<\/a> but have slowed in recent years<\/a>.<\/p>\n Whether workplace insurance is affordable significantly varies by income. According to 2020 KFF data<\/a>, lower-income families insured through a full-time worker spent, on average, 10.4% of their income on premiums and out-of-pocket costs. That\u2019s more than twice the rate when looking at families across all incomes.<\/p>\n Our Ruling<\/strong><\/p>\n Thune said, \u201cA lot of times, health care comes with a job.\u201d<\/p>\n This statement is partially accurate. Most workers in the U.S. get health coverage through work. But it glosses over aspects of our nation\u2019s job-based health insurance system \u2014 such as how costs and coverage, especially for those with lower incomes, can make an employer plan out of reach even if it is available.<\/p>\n Bottom line:<\/strong> Not all jobs provide health insurance or offer plans to all their workers. When they do, cost and quality vary widely \u2014 making Thune\u2019s statement an oversimplification.<\/p>\n We rate this statement Half True.<\/p>\n KOTA interview<\/a> with Sen. John Thune, May 30, 2025.<\/p>\n CNBC interview<\/a> with Sen. James Lankford, June 5, 2025.<\/p>\n KFF, \u201c2024 Employer Health Benefits Survey<\/a>,\u201d Oct. 9, 2024.<\/p>\n KFF, \u201cEmployer Responsibility Under the Affordable Care Act<\/a>,\u201d Feb. 29, 2024.<\/p>\n KFF, \u201cEmployer-Sponsored Health Insurance 101<\/a>,\u201d May 28, 2024.<\/p>\n Peterson-KFF Health System Tracker, \u201cWhat Are the Recent Trends in Employer-Based Health Coverage?<\/a>\u201d Dec. 22, 2023.<\/p>\n Peterson-KFF Health System Tracker, \u201cHow Affordability of Employer Coverage Varies by Family Income<\/a>,\u201dMarch 10, 2022.<\/p>\n Peterson-KFF Health System Tracker, \u201cTracking the Rise in Premium Contributions and Cost-Sharing for Families With Large Employer Coverage<\/a>,\u201d Aug. 14, 2019.<\/p>\n Manhattan Institute, \u201cPut Employees in Control of Health Insurance with \u2018Worker\u2019s Choice ICHRA,\u2019<\/a>\u201d May 22, 2025.<\/p>\n Brookings, \u201cUninsurance Rates Have Fallen Significantly Following the Affordable Care Act<\/a>,\u201d July 22, 2024.<\/p>\n Harvard Business Review, \u201cWhy Do Employers Provide Health Care in the First Place<\/a>?\u201d March 15, 2019.<\/p>\n Congressional Budget Office letter<\/a> on the One Big Beautiful Bill Act increasing the number of uninsured people, June 4, 2025.<\/p>\n Phone interview with Paul Fronstin, director of health benefits research at the Employee Benefit Research Institute and a member of the Commonwealth Fund\u2019s National Task Force on the Future Role of Employers in the U.S. Health System, June 6, 2025.\u00a0<\/p>\n Phone interview with Melissa Thomasson, professor and health economist at Miami University, June 6, 2025.<\/p>\n Phone interview with Maanasa Kona, associate research professor at the Center on Health Insurance Reforms at Georgetown University, June 6, 2025.\u00a0<\/p>\n Phone interview with Matthew Rae, associate director for the Health Care Marketplace Program at KFF, June 10, 2025.\u00a0<\/p>\n Phone interview with Sally Pipes, president and CEO of the Pacific Research Institute, June 11, 2025.<\/p>\n Email correspondence with Ryan Wrasse, communications director for Sen. John Thune, June 10, 2025.<\/p>\n KFF Health News, \u201cSome Employers Test Arrangement To Give Workers Allowance for Coverage<\/a>,\u201d Oct. 2, 2024.<\/p>\n KFF Health News, \u201cTrump\u2019s \u2018One Big Beautiful Bill\u2019 Continues Assault on Obamacare<\/a>,\u201d June 3, 2025.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nSources<\/h4>\n
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