The growth in employer-provided health insurance premiums has slowed significantly since passage of the Affordable Care Act but a new study suggests that trend has not benefited U.S. workers, whose out-of-pocket costs for deductibles and premium contributions are grabbing an increasing share of income.

The Commonwealth Fund, which analyzed health insurance costs in 31 states and the District of Columbia, said the rate of premium and deductible growth slowed markedly from 2010 to 2013, apparently contradicting critics who had warned that the Patient Protection and Affordable Care Act would accelerate premium increases.

The slowdown reflects a reduction in spending on health care services since 2009 and changes in how health care is delivered and paid for, the report says.

But on the other side of the coin, the fund said the costs that employees and their families pay out of pocket for deductibles and their share of premiums have continued to rise, consuming a greater share of incomes across the country.

“In all but a handful of states, average deductibles more than doubled over the past decade for employees working in large and small firms,” it continued. “Workers are paying more but getting less protective benefits.”

Average annual premiums — including what both employers and employees contribute — represent 20% or more of the median income in 37 states. That was the case in only two states in 2003, The New York Times noted.

Drew Altman, president of Kaiser Family Foundation, noted that shifting more health care expenses to employees is a popular strategy among employers. “Increasing cost-sharing is the tried and true way to keep their premiums down,” he told the Times. “We’re seeing a steady, slow increase in cost-sharing every year.”

According to the Commonwealth Fund, out-of-pocket costs including workers’ premium contributions and deductibles accounted for 9.6% of median household income in 2013, on average, up from 5.3% in 2003.

“Based on recent forecasts that predict an uptick in private insurance growth rates starting in 2015, securing slow cost growth for workers, families and employers will likely require action to address rising costs of medical care services,” the fund said.

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