Despite the slowdown in health insurance rate increases, premiums have more than doubled since 1999, according to an annual survey by the Henry J. Kaiser Family Foundation and the Health Research and Educational Trust. Researchers believe rates could spike next year due to the lagging economy, forcing the number of employers offering coverage to drop.

“We’ve seen peaks and valleys in premiums before,” said Drew Altman, president and CEO of the Kaiser foundation. “There is no evidence we’ve done much if anything to deal with the fundamental underlying drivers of health care costs. So this valley won’t last.”

Kaiser’s annual study is seen by researchers as among the most comprehensive. This year the study’s authors published a companion article online in the journal Health Affairs.

Researchers said the economic slowdown came after companies had made their health plan decisions for 2008, but they expect a combination of higher premiums, less generous coverage and fewer firms able to offer coverage next year.

“We may be seeing a tip of the iceberg of a trend toward less-comprehensive, skimpy health insurance for working people, with higher premiums and out-of-pocket costs,” Altman said.

Family plans now cost, on average, $12,680 annually, up from $5,791 in 1999. In the same period, workers’ wages grew 34 percent and general inflation rose 29 percent, Employers’ costs have increased 119 percent; workers now pay on average $3,354 for a family plan, up from $1,543 in 1999, a 117 percent increase. 

The rising costs have hit small employers (fewer than 200 employees) hardest. Many have turned to high-deductible health plans, which tend to have lower premiums, in order to offer health insurance to their workers.

The percentage of small employers offering health insurance hit a nadir of 45 percent last year but rebounded to 49 percent in 2008, according to the survey.

The survey also found that 35 percent of covered workers at companies with fewer than 200 employees face annual deductibles of $1,000 or more, more than doubling from 16 percent in 2006. Overall, 18 percent of employees face deductibles of more than $1,000.

An estimated 5.5 million workers, or 8 percent, are enrolled in consumer-directed plans—which offer a health savings account or health reimbursement arrangement—up from 5 percent last year.

Small firms showed the largest gain in this category, with 13 percent of covered employees at such companies enrolled in consumer-directed plans, up from 8 percent last year. Sixty percent of small companies said cost was the primary reason for switching to consumer-directed plans; 40 percent said their greatest challenge was communicating with employees about the change.

Deductibles also rose sharply for employees in more traditional forms of health insurance. Deductibles in PPOs, or preferred provider organizations, in which 58 percent of employees are covered, rose nearly $100, to an average of $560, in 2008.

The percentage of large employers (200 or more employees) offering retiree health benefits declined to 31 percent, statistically unchanged since last year, when 33 percent offered the benefit. In 1988, 66 percent of large employers offered retiree health benefits.

Employers are increasingly trying to reduce health care costs by improving the health of their employees by creating wellness programs.

Half of all firms offer at least one type of wellness initiative, such as weight-loss programs, gym-membership discounts or on-site exercise facilities, smoking-cessation programs, personal-health coaching, classes in nutrition or healthy living, Web-based resources for healthy living, or a wellness newsletter. Few firms, however, offer incentives for enrolling in wellness programs.

The survey of nearly 2,000 employers was conducted in the first five months of this year. At that time, 24 percent of employees identified paying for health insurance and medical care as a serious problem, ranking third behind paying for gas and finding a good-paying job or getting a pay raise. At the time the survey was taken this spring, most employers said they were likely to offer health benefits next year.