SOUTHLAKE, Texas (Reuters) - Real estate agent Lisa DeWaal serves coffee at a Starbucks outlet for four hours every morning before she goes to the office to start her "day job."
The reason has little to do with the state of the housing market and everything to do with the one big perk that 20 hours a week at the coffee counter provides: affordable health insurance for her and her three children.
While health experts say there are no statistics available, analysts say there are many Americans like DeWaal: people who have taken or stick to a job just for the health insurance.
It is a situation most Europeans, Canadians and others who enjoy national health services would find bewildering if not appalling and is one factor fueling the drive to reform the hugely expensive U.S. healthcare system.
"People will even stick with a job they feel boxed in on because of the healthcare benefits, especially if those benefits cannot be matched elsewhere," said Andrew Sum, a labor economics professor at Northeastern University.
U.S. company healthcare plans are usually subsidized by the employer. They are much more affordable and comprehensive than private plans that can exceed a $1,000 a month for a family, a huge burden for most households.
As a result, company plans can make even a low-wage job an attractive option.
Starbucks says its most economical plan, available to part- or full-time staff, costs the employee about $25 a month.
Such plans, of course, also have an impact on companies' bottom lines and are part of the rising price tag of U.S. healthcare.
Half Price Books, a privately held retail chain based in Dallas with 2,500 employees nationwide, says over the past few years the costs of providing the same coverage to its workers has risen about 9 percent per year.
Its employees pay nothing for its base plan just to insure themselves and they pay $183 a month to cover a family.
President Barack Obama and the Democratic-led Congress are working on a fundamental restructuring of the healthcare system this year, aiming to sharply reduce the total of 46 million Americans who now have no health insurance.
DeWaal, a realtor for Prudential Texas Properties in the affluent town of Southlake near Dallas, has avoided the ranks of the uninsured -- but she has to sweat for it.
"I probably work 60 hours a week because I'm a full-time realtor ... I get up at around 4 a.m. every week day," said DeWaal, 44, a South African immigrant and widow, who begins her Starbucks shift at 5 o'clock each morning.
DeWaal said her plan, which includes her children, cost her $46 a week or close to $180 a month.
"Health insurance is exactly the reason why I have taken the extra job. It's company health insurance, which is a lot better than a private plan. I would put these extra hours into real estate if I had affordable health insurance," she said.
June data from the U.S. Department of Labor showed about 7.1 million Americans were "multiple job holders," well down from 7.7 million in June 2008 as the job market shrank with the economy.
The need for affordable health insurance has forced some Americans out of retirement, especially if they left the work force before they reached an age where government programs like Medicare are available.
Patti Sutton, 58, used to work with the City of Phoenix and came out of retirement to whip up espressos at Starbucks for the same reason as DeWaal -- the health insurance.
Her husband Scott, who was laid off by the construction company he worked for, is awaiting a heart transplant.
"When he got sick, the costs skyrocketed," she said.
Patti went for two years without insurance and they used savings to cover health costs.
Scott Duncan, 43, said health benefits were one of the reasons he is sticking to his job at Half Price Books in Dallas, which sells second-hand books and magazines.
"I've worked here off and on for 10 years and the benefits made me inclined to stay," he said.
Duncan said his real estate agent wife was the main bread winner in the family but his job provided the health benefits for her and his three children.
"We could get private health insurance but it would take most of our paycheck," he said.
Additional reporting by Tim Gaynor in Phoenix, Editing by David Storey