Feelings Meet Facts: What We See When We Overlay Our Gallup Survey on the City Checkup

Nearly one in four U.S. workers, about 23 million people, say they're staying in a job they want to leave because they're afraid of losing their health insurance.¹ Researchers call this job lock, and according to new research from our West Health-Gallup Center on Healthcare in America, it's risen eight percentage points since 2021.^1,2 That's a feeling, captured the way we capture feelings through our Gallup research: by asking people directly, in a nationally representative survey of thousands of American adults.

Our City Checkup doesn't rely on public sentiment; it measures the structural conditions of 789 American cities straight from public records: poverty rates, chronic disease prevalence, rent burden, hospital density, none of it self-reported.^4,5 By pulling data from CDC, US Census, and ACS all in one place allows us to draw insights in the lived experience in ways that are new and never linked before. When we compared the City Checkup data next to Gallup’s data side by side, they describe the same country from two different perspectives. Our work with Gallup captures what people are experiencing. Our City Checkup shows the conditions sitting underneath that experience, city by city.

The feeling: What our Gallup polling says about being locked into a job for the insurance

Job lock isn't a fringe experience. It's risen from roughly one in six workers in 2021 to nearly one in four today, and it tracks financial strain almost exactly.¹ Workers carrying medical debt report job lock at more than double the rate of those without it, 44% versus 21%. Workers who borrowed money for care in the past year report it at 37%, against 22% for those who didn't. Among people who call healthcare costs a major financial burden, nearly half, 48%, say they're staying in a job for the coverage alone. That climbs to 53% among workers who describe healthcare costs as a source of “a lot” of daily stress.^1,2

Health itself compounds the effect. Workers with no chronic conditions report job lock at 17%. With one condition, that rises to 23%. With three or more, it reaches 41%, more than double the baseline.¹ Conditions that require ongoing management drive it hardest: 29% among people with asthma, 36% among people with immune-compromising conditions, 35% among people managing depression, 33% among people managing anxiety. Women report job lock at 30%, one and a half times more likely than men (20%), a gap that lines up with women also reporting more healthcare-related financial stress, more medical debt, and more chronic conditions than men.^1,2

None of this is happening in isolation. Our latest research with Gallup research finds that just 49% of U.S. adults can now consistently afford the care and prescriptions they need, the first time that figure has dropped below half in five years of tracking, and 51% say they're worried about affording healthcare at all over the next year.³ Job lock is downstream of that affordability crisis, not separate from it.

The data audit: How the City Checkup sees the conditions behind the feeling

Here's where our City Checkup picks up the thread. Our Financial domain tracks ten indicators, including poverty rate, rent burden, credit access, and energy costs, the same terrain that predicts job lock in our Gallup data, just measured from the outside rather than the inside.^4,5 Our Physical Health domain, the largest of the seven with 25 indicators, tracks chronic disease prevalence and premature death, the same terrain that drives job lock hardest among workers managing multiple conditions.⁵

Two cities already in this series make the connection concrete. Detroit sits at or near the 1st percentile nationally on both Financial and Physical Health, the same two conditions our Gallup's survey identifies as the strongest predictors of job lock.⁵ Cupertino sits at the 97th percentile on Financial, among the strongest financial standings of any of the 789 cities we measured.⁵ We never surveyed workers in either city specifically. We didn't need to. The structural conditions our City Checkup measures directly are the same conditions our own national survey shows are driving Americans to stay in jobs they want to leave.

A third domain belongs in this comparison, too. Job lock runs elevated among workers managing depression (35%) and anxiety (33%), well above the 17% baseline for workers with no chronic conditions at all.¹ Our Mental & Behavioral Health domain, eight indicators built from CDC PLACES data, tracks exactly this terrain: depression prevalence, frequent mental distress, and opioid overdose deaths, city by city.^4,5 A city carrying a weak Grade on that domain isn't an abstraction. It's a place where the specific health burden most tightly linked to job lock in the national data is already measurably concentrated.

It's worth being precise about what this comparison is and isn't. Our Gallup's survey wasn't designed to break job lock out city by city, and our City Checkup wasn't designed to ask anyone how trapped they feel. Neither tool can hand the other a single combined number. What they can do, and what we found is that they arrive at the same picture of American healthcare precarity by two completely independent routes, one asking people directly, one measuring the conditions around them. Two instruments built differently, pointed at the same reality, reading the same result.

Where our two datasets echo each other

Neither dataset is simple about who's most affected, and that's the most interesting place they agree. In our Gallup data, job lock doesn't rise in a straight line with need. It peaks among workers earning $48,000 to just under $90,000 a year, at 27%, higher than the rate among workers earning less than $48,000 (25%).¹ That's the coverage cliff: households too well-off for the safety net built around the lowest earners, but not well-off enough to absorb the cost of coverage on their own.

Our City Checkup shows a version of the same non-obvious pattern at the city level. A city's overall standing barely predicts how it does on any single domain, Financial included, which is why a place with real economic activity can still carry a weak Financial grade, and a small, quiet suburb can outscore cities many times its size.⁵ In both datasets, the headline number, income bracket or overall Grade, turns out to be a poor stand-in for the specific condition that actually determines whether someone is stuck.

What this means for aging in America

Chronic conditions accumulate with age, and job lock's clearest health signal, 41% among workers managing three or more conditions, falls hardest on people in their 50s and early 60s: old enough to be carrying real health history, not yet old enough for Medicare.¹ These are the years our research consistently points to as the most financially exposed stretch of American adulthood, and they're exactly where a national feeling and a set of local conditions converge. A worker in a low-Financial-grade city, already living with thinner economic infrastructure, managing a chronic condition, and still a decade from Medicare eligibility, is close to the worst-case overlap of everything both datasets measure.

That's not a reason for despair. It's a reason why we built the City Checkup. Our Gallup survey can tell you that millions of Americans feel stuck. Our 789-city data audit can tell a mayor, a hospital system, or a state legislator exactly which structural conditions, in which cities, are producing that feeling, and where investment would loosen the lock fastest.

Look up your city

West Health-Gallup's national numbers describe how Americans feel about their economic and healthcare position. Our City Checkup shows why, city by city, dimension by dimension. Search your city on the dashboard and look at its Financial and Physical Health standing specifically. Those two domains, more than any others, are where this national feeling is being built, block by block.

This is the third post in a series built around our City Checkup. The first covered the highest- and lowest-graded cities in the country; the second covered how those grades get built. This one connects the Checkup to the people it's ultimately meant to serve.

References

1. Gallup. “One in Four U.S. Employees Locked in Jobs for Health Insurance.” July 21, 2026. news.gallup.com/poll/712166/one-four-employees-locked-jobs-health-insurance.aspx

2. West Health. “1 in 4 American Workers Report Staying in Unwanted Jobs for Health Insurance” (press release). July 22, 2026. westhealth.org/news/1-in-4-american-workers-report-staying-in-unwanted-jobs-for-health-insurance/

3. Gallup. “U.S. Adults' Ability to Afford Healthcare at a Five-Year Low.” June 2026. news.gallup.com/poll/710942/adults-ability-afford-healthcare-five-year-low.aspx

4. West Health. “City Checkup Dashboard.” westhealthmosaic.com/data-mosaics/well-being-index-scores

5. West Health Data Science & Analytics. “How the West Health City Checkup Is Built: A Methodology Brief.” Updated August 2026.