When doctors diagnosed Jen Chan with an aggressive form of breast cancer last year, she and her wife, Emily, confronted surgery, chemotherapy, radiation and uncertainty about whether treatment would work. In April, Jen danced toward the chemotherapy ward bell as medical staff cheered, believing her grueling treatment had ended.

Follow up tests then found cancer cells in Jen’s lymph nodes, and doctors said she needed another year of chemotherapy. During one session, Emily received an email from insurance broker Trey Wilson warning that the couple’s insurance costs were about to soar.

The Chans own JenChan’s, a popular Chinese and pizza restaurant in Atlanta’s Cabbagetown neighborhood, and Mikkelson’s Market in Reynoldstown. Jen’s cancer care and an employee’s accident related surgery pushed claims upward, leaving the business facing doubled costs for everyone on its policy.

The predicament reflects a broader crisis for small businesses that want to protect employees and retain staff but have limited affordable insurance options. Industry surveys show that only about a third of US restaurants offer coverage.

Scott Bierman, vice president of government affairs for the Georgia Restaurant Association, said 9 in 10 of its members are small businesses and most cannot afford insurance. “Insurance is often a bridge too far for small businesses like restaurants. Many of our folks would like to offer this option, but they just can’t stretch it,” Bierman said.

Health insurance costs have remained the leading concern for small businesses for four decades, according to a March survey by the National Federation of Independent Business. Among surveyed small employers offering coverage, 98% believed high costs would make that benefit unsustainable within five to 10 years.

Hospitality employees are also among the least insured workers. A 2021 Bureau of Labor Statistics report found about 32% had health insurance, compared with 77% of all private sector workers.

The Chans consider insurance essential for their full time employees, even though their costs had already tripled four years ago. In 2024, they added an optional 4% health care surcharge to customers’ checks, drawing death threats after an out of town customer complained on social media.

The community rallied around the restaurant, and the Chans kept the fee, although Emily said it remained far from enough. Last year, they paid an average of about $491 monthly for each employee before that figure jumped to about $1,135 per person per month for the year.

In June, recent claims drove the monthly bill beyond $2,400 per person. The total reached $21,868.71, nearly four times the restaurant’s rent, for a policy that then covered nine employees, with more expected to join.

The struggle extended beyond cost. Jen’s doctor prescribed an immunotherapy drug that the insurer would not approve, forcing her to undergo a different treatment, while Emily repeatedly dealt with the insurance company and their insurance advocate.

Emily asked Wilson to search for a less expensive policy, but he said no other company would bid because of the group’s claims history. “This exact situation is why, as much as restaurants would like to offer insurance, it is incredibly difficult,” Wilson said.

Larry Levitt, executive vice president for health policy at KFF, said small businesses typically have limited affordable choices, including self-funded or partially self-funded policies. Such plans can base rates on past medical claims, leaving employers responsible for risk that large companies can spread among far more people.

The Chans’ plan is partially self-funded, so they directly pay toward claims up to a set limit before a larger insurer steps in. “The policies can seem really attractive and cheap if your employees are healthy, but if one person gets sick, it’s not such a good deal,” Levitt said.

By summer, the Chans faced steep medical bills and insurance costs they could not afford, but Emily said dropping coverage was not an option. Before launching a GoFundMe, they owed about $12,000 from Jen’s first treatments and had roughly $60,000 in pending medical bills.

More than 1,700 people donated over $128,000, helping cover medical and insurance expenses. The remaining money funded a type of health savings account for employees facing deductibles or unexpected costs.

The Chans’ experience mirrors a wider burden from medical debt. A March 2025 Gallup poll found about 30 million Americans reported borrowing money for medical care, while an Urban Institute report said more than a quarter of US adults had medical debt in 2025.

Jen continues chemotherapy and needs treatment through the end of the year. The Chans have vowed to maintain employee insurance, arguing that the system puts businesses like theirs in a terrible position even as their customers and neighbors continue offering support.

This summer, they held a Gala for Hope to thank supporters and raise money for the Giving Kitchen, an Atlanta nonprofit that helps restaurant workers in crisis. Attendance was so high that Jen and Emily never delivered their remarks because they spent most of the event cooking.

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