Few if any employers will returnto the much more generous coverage of a decade or more ago, butthey're reassessing how much pain workers can take. (Photo:Shutterstock)

With workers harder to find and Obamacare's tax on generous coverage postponed, employers arehitting pause on a feature of job-based medical insurance muchhated by employees: the high-deductible health plan.

Companies have slowed enrollment in such coverage and, in somecases, reinstated more traditional plans as a strong job marketgives workers bargaining power over pay and benefits, according toresearch from three organizations.

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This year, 39 percent of large, corporate employers surveyed bythe National Business Group on Health (NBGH) offer high-deductibleplans, also called “consumer-directed” coverage, as workers' onlychoice. For next year, that figure is set to drop to 30percent.

“That was a surprise, that we saw that big of a retraction,”said Brian Marcotte, the group's CEO. “We had a lot of companiesadd choice back in.”

Few if any employers will return to the much more generouscoverage of a decade or more ago, benefits experts said. Butthey're reassessing how much pain workers can take and whetherhigh-deductible plans control costs as advertised.

“It got to the point where employers were worried about theaffordability of health care for their employees, especially theirlower-paid people,” said Beth Umland, director of research forhealth and benefits at Mercer, a benefits consultancy that alsoconducted a survey.

The portion of workers in high-deductible, job-based planspeaked at 29 percent two years ago and was unchanged this year,according to new data from the Kaiser Family Foundation. (Kaiser Health News isan editorially independent program of the foundation.)

Deductibles — what consumers pay for health care beforeinsurance kicks in — have increased far faster than wages, even aspaycheck deductions for premiums have also soared.

One in 4 covered employees now have a single-person deductibleof $2,000 or more, KFF found.

Employers and consultants once claimed patients would becomesmarter medical consumers if they bore greater expense at the pointof care. Those arguments aren't heard much anymore.

Because lots of medical treatment is unplanned, hospitals anddoctors proved to be much less “shoppable” than experts predicted.Workers found price-comparison tools hard to use.

High-deductible plans “didn't really do what employers hopedthey would do, which is create more sophisticated consumers ofhealth care,” Marcotte said. “The health care system is just waytoo complex.”

At the same time, companies have less incentive to pare coverageas Congress has repeatedly postponed the Affordable Care Act's “Cadillac tax”on higher-value plans.

Although deductibles are treading water, total spending onjob-based health plans continues to rise much faster than theoverall cost of living. That eats into workers' pay in other waysby boosting what they contribute in premiums.

Employer-sponsored group health plans, which insure 150 millionAmericans — nearly half the country — tend to get less attentionthan politically charged coverage created by the ACA.

For these employer plans, the cost of family coverage went up 5percent this year and is expected to rise by a similar amount nextyear, the research shows.

Insuring one family in a job-based plan now costs on average$19,616 in total premiums, the KFF data show. The American workerpays $5,547 of that in a country where the median householdincome is more than $61,000.

The KFF survey was published Tuesday; the NBGH data, in August.Mercer has released preliminary results showing similar trends.

The recent cost upticks, driven by specialty drug costs andexpensive treatment for diseases such as cancer and kidney failure,are an improvement over the early 2000s, when family-coverage costswere rising by an average 7 percent a year. But they're stillnearly double recent rates of inflation and increases in workerpay.

Such growth “is unsustainable for the companies I have beenworking with,” said Brian Ford, a benefits consultant with LocktonCompanies, echoing comments made over the decades by experts ashealth spending has vacuumed up more and more economicresources.

For now at least, many large employers can well afford risinghealth costs. Earnings for corporations in the S&P 500 haveincreased by double-digit percentages, driven by federal tax cutsand economic growth. Profit margins are near all-time highs.

But for workers and many smaller businesses, health costs are aheavier burden.

Premiums for family plans have gone up 55 percent in the pastdecade, twice as fast as worker pay, according to KFF.

Employers' latest cost-control efforts include managing expensesfor the most expensive diseases; getting workers to use nursevideo-chat services and other types of “telemedicine”; and payingfor primary care clinics at work or nearby.

At the “top of the list” for many companies are attempts tomanage the most expensive medical claims — cases of hemophilia,terrible accidents, prematurely born infants and other diseases —that increasingly cost as much as $1 million each, Umland said.

Employers point such patients to the highest-quality doctors andhospitals and furnish guides to steer them through the system. Suchsteps promise to improve results, reduce complications and savemoney, she said.

On-site clinics cut absenteeism by eliminating the need foremployees to drive across town and sit in a waiting room for twohours to get a rash or a sniffle checked or get a vaccine,consultants say.

Almost all large employers offer telemedicine, but hardly anyworkers use it. Thirty-nine percent of the larger companiescovering telemedicine now make it comparatively less expensive forworkers to consult doctors and nurses virtually, the KFF surveyshows.

Kaiser Health News is anonprofit news service covering health issues. It is an editoriallyindependent program of the Kaiser Family Foundation, which is notaffiliated with Kaiser Permanente.

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