More than a quarter (28 percent) of all covered workers, including nearly half (45 percent) of those at small employers with fewer than 200 employees, were in plans with a deductible of at least $2,000, almost four times the share who faced such deductibles in 2009. One in eight (13 percent) faced deductibles of at least $3,000.

"The single biggest issue in health care for most Americans is that their health costs are growing much faster than their wages are," KFF's president and chief executive officer, Drew Altman, said. "Costs are prohibitive when workers making $25,000 a year have to shell out $7,000 a year just for their share of family premiums."

About 153 million Americans rely on employer-sponsored coverage.

Among firms offering coverage, employers with many lower-wage workers (earning $25,000 or less a year) offered health benefits to a smaller share of their workforce and required workers to pay a higher share of premiums than other employers. Specifically:

• Among firms that offered health benefits, two-thirds (66 percent) of workers at lower-wage firms were eligible for health benefits, significantly less than the share (81 percent) eligible at other firms.
• Family premiums at firms with many lower-wage workers averaged $17,633, 15 percent less than the average at other firms. At the same time, workers covered by lower-wage firms had an annual family contribution of $7,047. Workers at other firms contributed an average of $5,968 annually.
• One result was that fewer workers at lower-wage firms took up their employer's health benefits when offered. The net effect was that one in three (33 percent) workers at lower-wage firms offering health benefits were covered by their employer's health benefits, well below the 63 percent share at other offering firms.

"Employer-sponsored coverage doesn't come cheap for employers or workers, and many who work at low-wage firms or small business likely find it too costly to cover their families," said Gary Claxton, a KFF senior vice president and director of the Health Care Marketplace Project, and the lead author of the study.

The survey also gauged employers' experiences and views related to several provisions of the Affordable Care Act ("ACA").

In 2017, Congress eliminated the ACA's tax penalty for people who do not have health insurance effective for this tax year, raising questions about whether it would lead workers to drop their coverage. The survey found that nine percent of offering firms with at least 50 workers said the elimination of the individual mandate penalty led to fewer workers and dependents enrolling this year.

The ACA also included a tax on high-cost health plans, sometimes called the "Cadillac tax," that originally was set to take effect in 2018, although Congress delayed the tax until 2022, and the House recently voted to repeal it. The survey found that only 16 percent of offering employers with at least 50 workers said that they expected the tax to take effect in 2022. One-third of those firms said the upcoming tax was either "very" or "somewhat" important in making their health benefit decisions for the current year.

Other survey findings included:

• Offer rate held steady. The survey found 57 percent of employers offered health benefits, the same as last year and similar to a decade ago (59 percent). The larger an employer, the more likely it was to offer health benefits, with about half (47 percent) of the smallest firms (three to nine workers) and nearly all (99 percent) large firms (200 or more workers) offering coverage. Small employers who did not offer health benefits most often cited cost as the primary reason.
• Provider networks. The vast majority (83 percent) of offering employers said they were satisfied with the choice of providers available through their insurance plans. Few (five percent) said they offered a plan with a narrow provider network, which could help the plan negotiate lower payment rates but also reduces enrollee choices.
• Spousal coverage. Although most large employers offering health benefits covered spouses, 11 percent did not allow spouses to enroll if they had coverage from another source. Among those that did allow such enrollment, 10 percent required spouses to pay more through a larger premium contribution or higher cost sharing.
• Response to the opioid epidemic. Many large employers (at least 200 workers) reported taking specific steps over the past five years in response to the nation's opioid crisis. These included creating or revising an employee assistance program (40 percent); providing health information to workers (38 percent); limiting or otherwise modifying coverage for prescription opioids (24 percent); and asking their insurer or pharmacy benefit manager to increase monitoring of opioid use (21 percent).
• Dental and vision coverage. Among offering firms, 60 percent (including 92 percent of large firms) also offered separate dental insurance, while 46 percent (including 83 percent of large firms) also offered separate vision insurance. Employers said that they sometimes contributed toward the cost of these benefits, but employees sometimes were required to pay the full cost themselves.