Nearly half of all Americans with employer-based health insurance plans say more money is being taken out of their paychecks for health insurance compared to a year ago, and 44% are facing higher out-of-pocket expenses, including deductibles and copayment, according to a report by the Princeton Survey Research Assocs. International and Bankrate.com.

Americans with annual household incomes between $50,000 and $74,999 with employer-based health insurance have been impacted most: 47% of respondents in this demographic report a negative effect on their health insurance, a much higher percentage than any other income level.

“Since so much of the Obamacare conversation has focused on uninsured Americans and the government-run exchanges, it's easy to forget most Americans—about 150 million—get their health insurance from an employer,” said Bankrate.com insurance analyst Doug Whiteman.

Although many feared Obamacare would result in a loss of family coverage, fewer than 1 in 10 Americans with employer-based health insurance lost coverage for a spouse or child this year, and only 2 in 10 in this group have fewer doctors included in their coverage plans.

Whiteman suggests that those with employer-based health insurance be aware and prepared for any potential changes to their plans.

“People should discuss with their employers how Obamacare might affect their coverage and costs. In some cases, getting insurance through the health exchanges could be more cost–effective, so it is important to research all possibilities,” he said.

The survey shows that 48% of Americans would choose to repeal the Affordable Care Act, compared to 46% in September. Currently, only 36% would choose to keep it.

However, the survey reveals a slight overall improvement in individual health spending ability and access to quality care. When asked if their monthly spending on healthcare has risen in the last year, only 34% say yes, the lowest total in five months. When asked about the overall health insurance situation, 12% report it is improving, and 12% say it is getting worse. Last August, 20% claimed the situation was worsening, while 8% saw an improvement.

“That's consistent with the good news that is not generally recognized, which is that we're experiencing the slowest health care cost growth in decades,” said Judy Feder, professor of public policy at Georgetown University and a fellow with the think tank the Urban Institute.

“The Affordable Care Act is triggering a lot of changes to the healthcare delivery and payment systems all across the country,” she said. “There are many who think that this is creating a real tipping point in efforts to slow the growth of health care costs more systematically.”

Deborah Chollet, manager of health insurance research at Mathematica Policy Research, believes that the cost-shifting trend from employers to workers will eventually reach a conclusion when smaller employers give workers a “defined contribution” in cash, allowing employees to choose their own plan on the Small Business Health Options Program (SHOP) exchanges. The SHOP exchange offers coverage for businesses with fewer than 50 workers, allowing small businesses to affordably provide qualified health plans to employees.

“That is going to make people very aware of what they're paying out of their paycheck—they're going to see it move,” Chollet said. “The employee, not the employer, is going to go into this SHOP exchange and say, 'My boss has given me $500 a month to spend on insurance.' And that $500 is probably going to be the same, whether they have a spouse and children or not. So, almost by definition, they will have dropped spousal and family coverage in the small group market, if this plays out the way I think it will.”

A shift toward “defined contribution plans” will allow more small businesses to offer a wider variety of health coverage without sacrificing the administrative costs.

“Suddenly, you're the good guy; you're offering health insurance benefits. You're just not signing up for the rollercoaster,” Chollet said. “You can now control the cost of it.”

Employees may benefit as well. According to Chollet, “You should have a more stable job, more take-home pay, and possibly more employers offering defined contribution plans.”

These findings are based on Bankrate's fifth Health Insurance Pulse monthly survey, which was conducted on Dec. 19-22 by Princeton Survey Research Assocs. International with a representative sample of 1,005 adults living in the continental United States.

Special Reports /

Study: Nearly Half of Americans Say Cost of Employer-Based Plans Increasing

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