New research by Professors Jeff Harris and Peggy Hannon of the Department of Health Systems and Population Health calls for employer engagement in safety-net program access in order to advance public health.
As the nation continues to grapple with persistent health inequities, a new report published by Professors Jeff Harris, MD, MPH, MBA and Peggy Hannon, PhD, MPH of the Department of Health Systems and Population Health (HSPop) brings fresh urgency to a long-standing challenge: many low-wage workers eligible for public benefits like Medicaid and the Supplemental Nutrition Assistance Program (SNAP) remain unenrolled, limiting the programs’ potential to improve health outcomes and reduce disparities.
The study in the American Journal of Health Promotion underscores the essential role of publicly funded safety-net programs in addressing social determinants of health (SDOH)—the non-medical factors such as food security, stable housing, and healthcare access that fundamentally shape individual and population health.
“Our work shows the challenges faced by workers who earn low wages and the importance of maintaining, and increasing participation in, these programs,” said Harris.
While eligibility is widespread among low-wage workers, participation lags for several reasons: stigma, lack of awareness, and administrative burdens. The study also reveals wide variation in state-level efforts to facilitate access—where states actively promote and streamline enrollment, participation rates are markedly higher.
“Stigma associated with these programs is a big barrier,” Harris explained. “Lack of awareness is also an issue. Difficulty in access is another. As we showed, some states work much harder to facilitate participation, and they have higher participation. The non-entitlement programs also vary dramatically from state to state in their funding levels.”
In this context, Harris and Hannon argue that employers—particularly those in sectors with high concentrations of low-wage jobs—represent an underutilized but promising vector for policy implementation and health promotion. By providing information or partnering with third-party organizations that assist with enrollment, employers could help bridge the participation gap.
Such an approach may be especially critical now. “The two biggest risks are those who need the benefits but don’t use them and the risk that Congress will move to diminish them in order to cut expenditures in the short run.”
While critics have sometimes framed employer involvement in benefit enrollment as a deflection from paying living wages or providing comprehensive health insurance, the authors distinguish between large corporations and small employers with fewer resources. “Large, high-valuation corporations should [pay higher wages and provide health coverage],” Harris noted. “But small, low-wage employers are often unlikely to be able to.”
The shifting policy environment adds further urgency. “Many companies probably don’t see it as one of their roles to promote, and connect employees to, these programs. This has been changing over the past few years with the increase in awareness of the importance of SDOH to health. Today, we seem to be pulling back.”
The study calls on public health professionals and policymakers to view the workplace not just as a site of employment, but as a key point of intervention in the effort to increase benefit uptake and address systemic inequities. In a climate of fiscal uncertainty and political retrenchment, maximizing the reach and efficiency of existing programs could prove to be one of the most pragmatic and impactful strategies available.