Health insurance premiums across the country rose modestly this year and are expected to bump up 6.4 percent in 2009, according to two reports released this week. However, more workers are paying higher deductibles for fewer health benefits, the Kaiser Family Foundation survey released Wednesday found.

The second study, by human resource consultants Hewitt Associates, said Dallas costs per employee covered increased faster than the national average this year – and significantly faster than costs in either Houston or Austin. Hewitt's actuaries said it's difficult to explain the differences in increases between Dallas and other Texas cities. Often, differences in demographics or health plan competition influence cost increases. In other cases, increases simply vary from year to year, according to Bob Tate, chief health actuary at Hewitt.

According to the more comprehensive Kaiser study, the average cost of family coverage at U.S. firms rose 5 percent this year, to $12,680.

That is slightly lower than the general inflation rate of 5.5 percent reported in August. Early in this decade, health plan costs increased by double-digit percentages.

Still, for family coverage, costs have more than doubled since 1999, when premiums were $5,791, according to Kaiser. During the same period, wages increased 34 percent and general inflation rose 29 percent.

The Kaiser survey found that more workers are facing higher deductibles in part because of a gradual shift toward health savings accounts. HSAs provide a way for individuals to save for future health care costs, in much the same way 401(k)s let people save for retirement. But they must be paired with a high-deductible health plan.

The shift toward HSAs has mostly come in small businesses with three to 199 workers, according to Kaiser. More than one in three, or 35 percent, of covered workers in small businesses pay at least $1,000 out of pocket before their health plans kick in, up from 21 percent last year, the Kaiser report said.

"Health insurance is steadily becoming less comprehensive, and it's no wonder that in today's tough economic climate many families count health care costs as one of their top pocketbook issues," said Kaiser president and CEO Drew Altman.

The Hewitt study, unlike the one by Kaiser, predicts cost increases for the coming year.

It showed Dallas with an 8.1 percent health care cost increase this year, up from 6.6 percent in 2007. For 2009, Hewitt projects a 6.3 percent average rate increase in Dallas.

The cost per employee covered at major Dallas firms will increase from $9,277 this year to $9,865 in 2009, Hewitt said in its report, released Monday. Total costs for employees – including employee contributions to the plans and out-of-pocket costs – are projected to be $4,099 in 2009, up 9 percent from $3,763 in 2008.

Hewitt's actuaries said they get their numbers by analyzing information on more than 1,800 health plans throughout the country, including those from 300 major employers.

While Dallas health plan increases have tended to equal or exceed the national average in recent years, Austin has had a few years of very low rate increases. Houston's rate increases before 2007 were above or right around the national average. This year's 2.6 percent increase was the lowest that city has seen in eight years.