23 Million Americans Say They're Stuck in Jobs Just to Keep Health Insurance

Nearly one in four American workers with job-based health insurance say they're stuck. Not because they love the job. Because they're scared of losing coverage.

That's according to a new study from the West Health-Gallup Center on Healthcare in America, released Wednesday. The survey, conducted October 27 to December 22, 2025, with 5,660 U.S. adults from the Gallup Panel, found 24% of employed adults with employer-sponsored insurance report "job lock" — staying in a job they want to leave purely to keep health coverage. That's about 23 million people.

Five years ago, in 2021, that number was 16%. An eight-point jump is not noise.

"Anybody having to stay in a job just to keep their health insurance, knowing that they want to leave, is crazy," says Ellyn Maese, research director at the center, in comments to NPR. "That is a concerning figure, even if it's 10%. But when we're seeing it rise to 1 in 4 employees, that's pretty serious."

Sicker Workers, Worse Odds

The numbers get uglier for people with health problems. Gallup found 29% of workers with a chronic condition report job lock, versus 17% of those without one. Workers with three or more chronic diagnoses hit 41%.

Specific conditions matter too. Asthma sufferers report job lock at 29%. People with immune-compromising conditions hit 36%, according to Gallup's own published data.

Money makes it worse. Among workers carrying medical debt, 44% say they're trapped in a job for insurance, more than double the 21% rate among those debt-free, Gallup reports. Borrow money for healthcare in the past year? Your job-lock rate jumps to 37%, versus 22% for those who haven't borrowed.

The most extreme number: 53% of workers who say healthcare costs cause them "a lot of stress" report staying in unwanted jobs to keep coverage.

Interestingly, job lock doesn't rise cleanly with poverty. Gallup found it peaks at 27% among households earning $48,000 to under $90,000 a year, and tends to be lower for higher earners. This looks less like a story about the poorest Americans and more about the middle, people who have something to lose and no easy way to replace it.

Why Now

The timing lines up with a broader affordability panic. An April KFF poll found nearly two-thirds of adults are anxious about affording healthcare, tied with gas and transportation as the top financial worry, according to Larry Levitt, KFF's executive vice president for health policy.

"Healthcare tops the list of economic worries right now," Levitt told NPR. "So it stands to reason that people would be concerned about leaving an unwanted job for fear of losing their health insurance."

One concrete policy shift sits behind the trend. Congress boosted ACA marketplace subsidies for middle-income buyers in 2021. Those enhanced subsidies expired at the end of 2025 under the Trump administration, and premiums were expected to rise by an average of 75%, according to analysis from the Peterson Center on Healthcare and KFF cited by Newsweek. Levitt says that expiration removed a safety net that used to let people quit and buy their own coverage.

The subsidies lapsed, and every source in this reporting, including Newsweek on the center-right, agrees insurers are now filing for further premium increases next year. Where it gets more contested is interpretation. Newsweek frames the ACA subsidy expiration and Medicaid changes as Trump administration decisions with a direct causal line to rising job lock. That's accurate as far as it goes, but Congress, not the administration alone, let the subsidies lapse rather than renewing them, and the enhanced credits were themselves a temporary pandemic-era expansion, not a permanent feature of the ACA. Whether letting a temporary subsidy expire counts as a "cut" or a return to baseline is a legitimate policy argument, not a settled fact.

Not everyone views employer-based coverage as the villain. Mark Pauly, a professor of health care management at the University of Pennsylvania, told Newsweek the rising numbers might reflect that "the value of benefits is higher now" — meaning workers are rationally choosing to stay put because the wage-and-benefits package got more valuable, not just because they're trapped.

Michael Cannon, director of health policy studies at the libertarian Cato Institute, takes a more structural view. "Everyone acknowledges that job lock is real," he says, arguing that tying insurance to employment, regardless of the exact percentage affected, "creates coverage gaps, reduces income mobility." Cannon's critique isn't new. Libertarian and free-market economists have argued for decades that the employer-insurance system itself, a byproduct of WWII-era wage controls and tax policy, is the root problem, not any single administration's subsidy decision.

What's Unresolved

Gallup's own researchers expect this to get worse before it gets better. Maese points to early insurer filings suggesting ACA premiums may rise again next year, driven by hospital, physician, and drug costs.

The open question is whether Congress revisits the expired subsidies, extends some alternative, or leaves the marketplace as is. Nothing currently pending in Congress as of this reporting reverses the 2025 expiration. Until something changes on that front, or employer-based coverage itself gets restructured, the 23 million Americans in job lock have no clear off-ramp.