West Health-Gallup Survey Reports 24% of U.S. Workers Stay in Jobs to Keep Health Insurance

A Growing Number of Workers Feel Stuck

A new survey says nearly one in four employed Americans are staying in jobs they would rather leave, just to keep their health insurance^[1]. The share is 24% of workers who get coverage through an employer. That works out to about 23 million people^[1][2].

Researchers have a name for this: job lock. It means someone keeps a job mainly for the benefits, not because they want the work^[3][10]. Four years ago, the same question found 16% of workers felt trapped this way. The rise to 24% is an eight-point jump^[1].

The findings come from the West Health-Gallup Center on Healthcare in America. West Health is a nonprofit funded by philanthropists Gary and Mary West, and it campaigns to lower health costs. Gallup ran the polling on West Health's behalf^[1]. The survey used the Gallup Panel, questioning 5,660 U.S. adults between October 27 and December 22, 2025. The 24% job-lock figure comes from a subset of 2,322 employed people who rely on employer coverage^[1].

It is worth noting what the number does and does not measure. It is self-reported. People were asked how they feel, not tracked to see if they actually quit or stayed^[1]. That does not make the finding wrong, but it does mean the true scale of job lock is softer than a clean percentage suggests.

What Both Sides Agree On

Almost no one disputes that job lock is real or that it grew. The dispute is over why it grew and what to do about it.

The survey found the burden falls hardest on the sickest and most indebted workers. Among people with three or more chronic health conditions, 41% said they stay in a job just for the insurance^[1][2]. Among workers carrying medical debt, 44% reported job lock, compared with 21% of workers without medical debt^[1][4].

Those numbers point to a structural fact: in the United States, health coverage is usually tied to employment. That was true before this survey and it will remain true regardless of who is right about the cause of the recent jump^[6][10].

Why Insurance Got Tied to Jobs in the First Place

To understand the argument over job lock, it helps to know how U.S. health insurance ended up bundled with employment at all. The tax code allows employers to buy health coverage for workers using pre-tax dollars. If the same worker tried to buy an identical plan on their own, they would have to pay for it with money the government has already taxed^[6].

That tax break, dating back roughly a century, makes employer-sponsored insurance far cheaper than anything an individual could buy alone^[6]. It also means the coverage is not portable. Leave the job, and the plan goes with the paycheck. This is the mechanism underneath the whole debate: not a law that traps anyone, but a tax rule that makes job-based coverage the cheapest option by far, while making individually owned coverage comparatively expensive^[6].

That imbalance is what libertarian critics point to when they call job lock a government-created problem, not a market failure. It is also why anyone hoping to loosen the lock has two very different tools available: make the employer-tied system less necessary, or make the outside alternative more affordable.

The Second Pressure: A Pricier Off-Ramp

The other force at work is more recent. Enhanced subsidies for Affordable Care Act (ACA) marketplace plans, first put in place in 2021 and extended by the Inflation Reduction Act, expired on December 31, 2025^[9]. Those subsidies had made it cheaper for people to buy their own insurance outside an employer.

With the enhanced credits gone, the average premium paid by a subsidized ACA enrollee is projected to rise sharply, from about $888 in 2025 to about $1,904 in 2026, according to KFF^[9]. That is more than double.

Congress tried to act. A discharge petition, a procedural tool that lets a House majority force a floor vote over leadership's objections, reached the needed 218 signatures on December 17, 2025, after four Republicans signed on^[9]. The House went on to pass a three-year subsidy extension in January 2026 by a vote of 230 to 198, with 17 Republicans joining Democrats^[9]. The Senate rejected it. The bill fell short of the 60 votes needed to advance, with Majority Leader John Thune opposed^[9]. As of July 2026, the subsidies had not been restored^[9].

How Each Side Sees It

People on the political left, including outlets like NPR and Newsweek, connect the rise in job lock directly to that expired subsidy and to the Trump administration's decision to let it lapse^[7][9]. In this view, job lock rises when the one real alternative to employer coverage, the ACA marketplace, becomes unaffordable. Restoring the enhanced subsidies, they argue, would directly ease the lock by making it safer to leave a job^[7]. Some point to projections that the expired credits could cost hundreds of thousands of jobs nationwide^[7].

Libertarians and many conservatives, represented here by the Cato Institute's Michael Cannon, accept the same 24% figure but trace it to a different root: the century-old tax exclusion that makes employer coverage artificially cheap^[3][6]. Cannon argues that favoring job-based insurance "creates coverage gaps, reduces income mobility, and is crying out for reform^[3]." Cato's proposed fix is to end the tax exclusion and let workers control the roughly $1 trillion employers currently spend on their behalf, using it to buy portable coverage they own and can carry between jobs^[6].

Each side has a clear stake in its preferred explanation. Democrats and ACA advocates have an interest in defending and expanding a program they built, and in tying rising health costs to Republican inaction ahead of the 2026 elections^[7][9]. Libertarian and free-market advocates have an interest in shrinking government's role in health coverage and shifting money and control from employers and Washington to individual workers^[6]. Neither camp disputes the underlying survey data. They disagree on which lever, subsidies or tax reform, would actually set workers free.

West Health and Gallup, for their part, frame the trend as an economic warning sign. The organizations argue that when workers stay in jobs purely out of fear, it means lost productivity, stalled careers, and businesses struggling to hire the people they actually want^[1][2]. West Health's own language calls the increase "a concerning sign for the U.S. economy^[1]."

How the Coverage Split

News outlets largely agreed on the numbers but differed in how they framed them. Gallup's own release adopted West Health's term "locked" and called the trend concerning, without heavily foregrounding the caveat that the data is self-reported. NPR reported the figures straightforwardly but added the ACA subsidy context and the Cato reform argument, which tilted its takeaway toward policy fixes that make it easier to leave a job.

STAT offered the most evenly balanced treatment, giving real space to the libertarian tax-exclusion critique alongside the affordability argument. Newsweek's coverage more directly named the Trump administration's decision to let subsidies expire as a factor and cited the sharp projected premium increase. U.S. News folded the survey into a broader story about public anxiety over politics and health costs.

The Cato Institute's own writing was the most openly one-directional of the sources reviewed, since it exists to advocate for a specific reform: ending the tax exclusion. That is consistent with its role as a think tank, not a news outlet, but it means readers should weigh its framing accordingly.

Coverage of the survey was almost entirely a U.S. story. No significant non-Western reporting on this specific survey turned up, though employer-tied health coverage is often described abroad as a distinctly American arrangement.