Nearly half of all Americans with employer-based healthinsurance plans say more money is being taken out of theirpaychecks for health insurance compared to a year ago, and 44% arefacing higher out-of-pocket expenses, including deductibles andcopayment, according to a report by the Princeton Survey ResearchAssocs. International and Bankrate.com.

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

“Since so much of the Obamacare conversation has focused onuninsured Americans and the government-run exchanges, it's easy toforget most Americans—about 150 million—get their health insurancefrom an employer,” said Bankrate.com insurance analyst DougWhiteman.

Although many feared Obamacare would result in a loss offamily coverage, fewer than 1 in 10 Americans withemployer-based health insurance lost coverage for a spouse or childthis year, and only 2 in 10 in this group have fewer doctorsincluded in their coverage plans.

Whiteman suggests that those with employer-based healthinsurance be aware and prepared for any potential changes to theirplans.

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

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

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

“That's consistent with the good news that is not generallyrecognized, which is that we're experiencing the slowest healthcare cost growth in decades,” said Judy Feder, professor of publicpolicy at Georgetown University and a fellow with the think tankthe Urban Institute.

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

Deborah Chollet, manager of health insurance research atMathematica Policy Research, believes that the cost-shifting trendfrom employers to workers will eventually reach a conclusion whensmaller employers give workers a “defined contribution” in cash,allowing employees to choose their own plan on the Small BusinessHealth Options Program (SHOP) exchanges. The SHOP exchange offerscoverage for businesses with fewer than 50 workers, allowing smallbusinesses to affordably provide qualified health plans toemployees.

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

A shift toward “defined contribution plans” will allow moresmall businesses to offer a wider variety of health coveragewithout sacrificing the administrative costs.

“Suddenly, you're the good guy; you're offering health insurancebenefits. 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 shouldhave a more stable job, more take-home pay, and possibly moreemployers offering defined contribution plans.”

These findings are based on Bankrate's fifth Health InsurancePulse monthly survey, which was conducted on Dec. 19-22 byPrinceton Survey Research Assocs. International with arepresentative sample of 1,005 adults living in the continentalUnited States.