The number of Americans getting health care coverage through the workplace has dropped for the 11th year in a row, continuing a slide that began long before the Great Recession but that has lingered amid soaring insurance costs.

In 2011, 58.3 percent of the nation's workers under 65 had job-based health insurance, according to a report released Wednesday by the Economic Policy Institute.

That marks a decline of 0.3 percentage points from the previous year, after precipitous declines starting in 2008, when companies were laying off workers, shuttering plants or going out of business in the wake of the global financial crisis.

"What is so clear is that workers have lost bargaining power," said Elise Gould, author of the study and director of health policy research at the Washington-based think tank. "There are so many workers for every job out there, and workers don't have any way to get higher wages or better benefits. That's why that trend is not going to improve."

Minnesota workers fared better than the nation, but still lost ground. About 68.7 percent of workers in the state got health care benefits through their employers in 2011, fourth-highest rate in the nation.

But that number has fallen by 8.6 percentage points over the past decade, compared with a larger drop nationwide of 10 percentage points. The decline has left nearly 319,000 Minnesota workers without job-based coverage, though the effect likely is much broader because it doesn't account for a growing population.

"The big takeaway is there's been a sizable decrease in employer-sponsored insurance across the country, not just in Minnesota," said Julie Sonier, deputy director of the Minnesota State Health Access Data Assistance Center, which tracks similar data. "It's a pretty broad-based problem, affecting all ages and income groups."

Many families have been shielded by early provisions of the Affordable Care Act, Gould said. Insurers no longer can deny coverage to children with pre-existing conditions and young adults can stay on their parents' workplace plans until they turn 26.

Still, workers 19 to 65 were 30 percent more likely to be uninsured in 2011 than in 2000.

"Even for employers who do offer it, sometimes workers have to decline that coverage because it's just too expensive when they have to meet so many other bills," Gould said.

Taxpayers picked up the tab where employers left off, as millions of American families turned to public programs for care. If workplace benefits had remained at 2000 levels, as many as 29 million more people would have been covered by workplace plans, according to the report.

The bulk of President Obama's health care law won't go into effect until 2014, including tax credits and other incentives to lower the cost of premiums for consumers, as well as insurance exchanges aimed at helping families and small businesses comparison shop for coverage.

Meanwhile, workplace hiring remains sluggish, businesses are building up cash reserves and health care costs continue to rise. Gould expects the downward trend in coverage to continue.

"Generally, we haven't seen a lot of compensation growth over this period," she said. "There are rising costs, and who is going to pay for those?"

Jackie Crosby • 612-673-7335