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One of the larger bills most people pay — their monthly health insurance premium — is rising rapidly amid the intense national debate over health care costs.

But because most employers pay part of the cost and the rest is deducted from workers' paychecks, consumers are insulated from the full cost of their health insurance and the escalation often gets overlooked.

"That makes no sense to me," said David Hodges, a Santa Rosa health insurance broker. "It's a pocketbook issue."

In California, the average annual premium last year was $13,400, up 9 percent from 2007, a rate three times higher than the overall rise in the cost of living. Employers on average paid about three-fourths and workers paid the rest, according to the California Healthcare Foundation.

Since 2002, health insurance premiums have more than doubled.

The prognosis for businesses and their employees next year is for another round of rate increases, some in double digits, insurance industry experts said. Many of those impacts will be presented to employees during open enrollment later this year.

Bucking the trend was CalPERS, which provides health coverage for nearly 1.3 million active and retired California public employees. In June, it announced an overall 3.2 percent premium increase for 2010, the lowest in 14 years.

In Sonoma County, nearly 56 percent of the population has job-related health care coverage and another 9 percent has privately purchased plans, according to the 2007 California Health Interview Survey.

Eight percent of county residents are uninsured and the rest have government-sponsored coverage, including Medicare and Medicaid.

Businesses and insurers are coping with the cost crunch in a variety of ways, including higher deductibles, more emphasis on wellness programs and requiring workers to pay more of the costs.

More than one-third of employers said they were likely to boost the amount employees pay for insurance this year, the Healthcare Foundation said.

For many businesses, rising health care payments are competing with company dollars for employee raises.

Employers see health care as "a growing part of compensation" that must be considered in determining wages, new hires and layoffs, said Marian Mulkey of the Healthcare Foundation, a nonpartisan Oakland think tank.

"Everybody is bemoaning the cost of insurance," said Sue Nelson, chief operating officer of the Santa Rosa Chamber of Commerce.

The economic slump, forcing many businesses to trim wages and benefits, makes it all the more painful to deal with double-digit increases in health care costs, she said.

Many businesses "are already on thin margins," said Cynthia Murray, president of the North Bay Leadership Council, a group that represents 33 employers in Sonoma and Marin counties.

Kaiser Permanente's integrated system, providing both insurance and medical care, provides many businesses a low-cost option. With 7 million subscribers statewide and 172,000 in Sonoma County, Kaiser is the dominant entity in California health insurance — but it's not immune from rising premiums.

Kaiser HMO premiums went up 8 percent to 10 percent this year, while the premium for the plan with deductibles of $1,000 or $1,500 increased 11 percent to 15 percent, Hodges said.

Kaiser has not announced premiums for 2010, but the increase is expected to be 1 percent lower than this year, said Hodges, who maintains health insurance plans for more than 400 companies from San Diego to Seattle.

Judy Coffey, a Kaiser executive and area manager for Sonoma and Marin counties, said the insurer does not disclose rate increases or ranges to the public. "Our goal for 2010 is to ensure stability that will help our customers better predict their health care costs from one year to the next," she said.

In the Santa Rosa city schools, health care premiums for about 300 non-teaching employees went up 10 percent this year, Associate Superintendent Doug Bower said.

With the district's contribution to the health care capped at $560 a month, employees had to cover the entire increase, he said.

The Healthcare Foundation hasn't tabulated premium increases for 2009, but Mulkey said she expects they will continue to outpace inflation, driven by relentless increases in the cost of American medicine.

Insurance industry regulations under consideration by Congress may give more people the opportunity to buy insurance, but Mulkey said it's unclear if the legislation will rein in the cost of care.

Health insurance claim amounts are expected to rise 10.5 percent in the next 12 months, said Aon Consulting, a Chicago-based employee benefit consulting firm that surveyed 60 health care insurers representing more than 100 million people.

Since 2004, claims have averaged a 12 percent annual increase, Aon said.

With expenditures of $2.5 trillion — amounting to more than $8,100 per person a year — the United States has the world's most expensive health care system.

Spending for hospital visits, physicians' services and other medical services is expected to grow more than 6 percent a year for the next nine years, nearly three times faster than the Consumer Price Index, hitting $4.4 trillion in 2018, according to the U.S. Department of Health of Human Services.

Sophisticated medical technology, such as CAT scans and MRIs, are driving up health care costs, along with an aging population beset with chronic health conditions such as diabetes and obesity, said Tom Lerche of Aon Consulting.

Employers are fighting back with wellness programs, which help workers quit smoking, get more exercise, change their diet and lose weight.

"It's the big push in the corporate world," Murray said.

Providing regular health care to many of the 46 million uninsured Americans would also reduce costs, Lerche said, by eliminating the shift of costs for treating uninsured people at hospital emergency rooms onto those with insurance.

"There is reason to be optimistic," he said.

Insuring more people, possibly through a government-run program like the "public option" in the health care overhaul being considered by Congress, would help, Hodges said.

"The bigger the number, the better it works," said Bob Shirrell, a Santa Rosa health care consultant.

But a contrary trend is the tendency of people worried about losing their job — and insurance — to go in for "semi-elective surgery," such as a hernia repair or joint replacement, Shirrell said.

If the recession and stock market losses prompt people to postpone retirement, the graying work force will become more expensive to insure, Murray said.

You can reach Staff Writer Guy Kovner at 521-5457 or guy.kovner@pressdemocrat.com.