No, it's not your imagination: Employers this year continued to shift more of the cost of health care to their employees.

Premiums for employer-sponsored health insurance rose 5 percent, to an average of $12,680 per family in 2008, a relatively small increase during a year in which health plans competed hard for business and when there were no new blockbuster drugs. The employee's portion of that premium was $3,354.

But for a growing number of workers, benefits are shrinking; 18 percent of employees now face deductibles of at least $1,000, up from 12 percent of workers last year, according to a survey released Wednesday by the Kaiser Family Foundation and the Health Research & Educational Trust, two independent think tanks.

The shift was most marked in small businesses of three to 199 workers, where one in three employees have deductibles of $1,000 or more, compared with one in five last year.

"More people are in less-comprehensive plans where they're paying for more health care, which explains why we are seeing the growing anxiety out there," Kaiser President and Chief Executive Drew Altman said.

The trend is driven mainly by employers' efforts to cut costs, but also by the idea that employees will be more careful about medical spending if they are paying for some of it directly. Some of the high-deductible plans come with health savings accounts, under which employees can put away pretax dollars for medical spending. Employers sometimes also contribute to the accounts.

Urgency may be lost

The Kaiser survey was conducted between January and May, and included 2,832 companies that have three or more employees.

The erosion of health benefits is coming at a time when consumers are hurting from high fuel and food prices, and struggling to pay their mortgages.

Although both major-party presidential candidates have stressed health-care reform as a priority, the recent turmoil in the nation's financial markets is likely to push health care down the political agenda, Altman said.

"It's likely that something more incremental and less comprehensive will result," he said.

There's growing evidence that some of those facing big deductibles are having trouble paying their medical bills.

A report from another Washington think tank also out Wednesday said that one in five Americans had trouble paying medical bills last year, compared with one in seven in 2000. These included those who have insurance as well as the uninsured.

All income levels affected

The Center for Studying Health System Change said that the problem increased for all income levels, though it was most severe for those who have low incomes. About 10 percent had debt of $12,000 or more.

Meanwhile, Minnetonka-based UnitedHealthcare -- one of the biggest purveyors of plans with health savings accounts -- offered its own analysis of how people were using the accounts.

UnitedHealth said that only 68 percent of account holders were putting money in their health savings accounts.

However, the study also found that 88 percent had money left over in the accounts at the end of the year -- some because of employer contributions. UnitedHealth said the high number of positive balances at year's end were an "encouraging indicator of HSAs' ability to help make health care more affordable."

The study examined 212,000 individuals enrolled in UnitedHealth's Definity health savings accounts in 2006.

Chen May Yee • 612-673-7434