Nearly one in four American workers — approximately 23 million adults — report staying in jobs they want to leave because they are afraid of losing their employer-sponsored health insurance, a new study from the West Health-Gallup Center on Healthcare in America finds. The figure represents an eight-percentage-point increase from 16% in 2021, the last time Gallup measured the phenomenon researchers call “job lock.” The surge coincides with the expiration of expanded Affordable Care Act marketplace subsidies in 2025, which had provided financial assistance to middle-income workers buying their own coverage — and which, for a window of time, gave would-be entrepreneurs and job-changers an alternative to employer-tied plans.
Key Takeaways
- Approximately 24% of U.S. workers with employer-sponsored insurance report staying in unwanted jobs to keep their coverage, up from 16% in 2021 — an eight-percentage-point increase representing roughly 23 million adults.
- Workers managing three or more chronic health conditions report a 41% job-lock rate, nearly double the overall figure.
- Half of all workers who describe themselves as highly stressed by healthcare costs say they remain in their current positions specifically because of insurance.
- Annual family premiums for employer-sponsored coverage rose 6% in 2025, approaching $27,000, with workers paying an average of $6,850 out of pocket toward premiums alone.
- The study, conducted October 27 to December 22, 2025, surveyed 5,660 U.S. adults and was published as a joint initiative of Gallup and West Health.
What Is Job Lock and Why Is It Getting Worse?
Job lock describes a labor market condition in which workers remain in positions they would otherwise leave because their health insurance is tied to their employer. The West Health-Gallup study identifies the phenomenon as a structural constraint on workforce mobility, one that prevents workers from pursuing higher-paying positions, starting businesses, or leaving toxic work environments. Ellyn Maese, a research director for the West Health-Gallup Center, described the trend in stark terms, noting that even a 10% job-lock rate would be concerning — but at one in four employees, the figure represents a serious drag on both individual welfare and the broader economy.
The timing of the increase points to a specific policy catalyst. In 2021, Congress expanded financial assistance for middle-income Americans purchasing insurance through ACA marketplaces, effectively giving workers an affordable alternative to employer-sponsored plans. When Congress allowed those enhanced subsidies to expire in 2025, the safety net for workers considering a job change or self-employment disappeared. The eight-percentage-point rise in job lock between 2021 and late 2025 maps almost directly onto that policy reversal.
Rising premium costs have compounded the problem. The Kaiser Family Foundation reported that annual family premiums for employer-sponsored coverage climbed 6% in 2025 to nearly $27,000, with workers contributing an average of $6,850 toward premiums out of their own paychecks. For a worker weighing a move to a smaller employer without comparable benefits — or to self-employment with no group plan at all — the math creates a powerful incentive to stay put regardless of job satisfaction, career trajectory, or workplace conditions.
Which Workers Are Hit Hardest by Job Lock?
The study reveals that job lock concentrates most heavily among workers with chronic health conditions and those already under financial strain from medical costs. Among working adults managing three or more chronic conditions, 41% reported staying in their current position solely for insurance — nearly double the overall rate. For these workers, leaving an employer plan means risking coverage gaps, higher premiums on the individual market, and potential lapses in ongoing treatment.
Financial stress amplifies the effect further. Half of all workers who described themselves as highly stressed by healthcare costs reported remaining in jobs they wanted to leave because of insurance considerations. The study, which surveyed 5,660 U.S. adults between October 27 and December 22, 2025, used a nationally representative sample and was conducted as part of the West Health-Gallup Center on Healthcare in America, a joint initiative focused on tracking how Americans experience the healthcare system.
Middle-income workers face a particular squeeze. They earn too much to qualify for Medicaid or other public assistance programs but not enough to absorb the full cost of individual-market premiums without subsidies. Maese described this population as workers who are “stuck in the middle, where they don’t really qualify for assistance but also don’t make enough to keep up with rising costs.” That middle band includes a significant share of the workforce in high-cost metropolitan areas, where healthcare premiums, housing costs, and the cost of living compound to make any disruption in employer-sponsored coverage feel financially existential.
What Does Job Lock Mean for New York’s Workforce and Economy?
The findings carry particular weight for New York City, where healthcare premiums rank among the highest in the nation and where the city’s identity as an entrepreneurial hub depends on workers’ ability to move freely between employers and into self-employment. Mayor Mamdani’s OPEN for Small Business initiative, announced just days before the Gallup report’s publication, aims to reduce regulatory barriers for the city’s 180,000 small businesses — but the job-lock data suggests that a significant share of potential entrepreneurs may never get to the starting line if insurance anxiety prevents them from leaving their current positions.
The labor mobility problem also affects employers competing for talent in a tight market. When workers cannot leave dissatisfying positions, the result is not stability but stagnation — reduced productivity, lower engagement, and a workforce that stays out of necessity rather than commitment. For New York’s finance, professional services, and creative sectors, where talent fluidity drives innovation and deal-making, job lock represents a hidden friction cost that does not appear on any balance sheet but shapes hiring outcomes across the economy.
Where Does the Policy Debate Stand?
Policy analysts across the ideological spectrum agree that the current system needs reform, though they diverge on the direction. Some researchers advocate for restoring the expanded ACA marketplace subsidies that expired in 2025, arguing that affordable individual-market options are the most direct way to break the link between employment and insurance. Others, including Michael Cannon of the Cato Institute, favor restructuring the insurance market entirely — moving toward portable individual coverage that workers own and carry between jobs, rather than plans tied to a specific employer. Cannon noted that regardless of the precise job-lock percentage, the employer-centered insurance model “creates coverage gaps, reduces income mobility, and is crying out for reform.”
The political reality is that neither approach is advancing in Congress, where the current session has been consumed by government funding fights and midterm positioning. The ACA subsidy expiration passed without a replacement framework, and no legislation addressing portable insurance is currently moving through committee in either chamber.
FAQs
What Is Job Lock?
Job lock is a labor market condition in which workers remain in positions they want to leave because their health insurance is tied to their employer. The West Health-Gallup study found that 24% of U.S. workers with employer-sponsored insurance — roughly 23 million adults — currently experience job lock, up from 16% in 2021.
Why Did Job Lock Increase Between 2021 and 2025?
The primary factor is the expiration of enhanced ACA marketplace subsidies that Congress allowed to lapse in 2025. Those subsidies had provided financial assistance to middle-income workers purchasing insurance outside of employer plans, giving them an affordable alternative. Without that support, the individual insurance market became significantly more expensive for workers considering a job change.
Which Workers Are Most Affected by Job Lock?
Workers managing three or more chronic health conditions report the highest job-lock rate at 41%. Half of all workers who describe themselves as highly stressed by healthcare costs also stay in unwanted positions for insurance. Middle-income earners who do not qualify for public assistance but cannot absorb full individual-market premiums are particularly vulnerable.
How Does Job Lock Affect New York City’s Economy?
New York City’s healthcare premiums rank among the highest nationally, and the city’s economy depends heavily on workforce mobility across finance, professional services, and the startup ecosystem. Job lock constrains the flow of talent between employers and into self-employment, reducing entrepreneurial activity and limiting the ability of businesses to attract workers who are effectively tethered to their current employers by insurance.
The eight-percentage-point rise in job lock over four years quantifies a workforce constraint that economists have long theorized but rarely measured at this scale — and without a policy intervention, the gap between where 23 million Americans work and where they want to work will continue to widen.
