Employers grappling with family insurance costs that rival the price of a new sedan are increasingly setting up onsite clinics and negotiating directly with health systems to better control their medical spending, according to a new KFF survey of workplace coverage.

• What they aren't doing, for the moment, is saddling workers with a disproportionate share of rising health expenses.

The big picture: Corporations and workers are sharing the pain as health cost increases are projected to hit their highest levels in decades. And workplace insurance remains a linchpin of the health system, covering almost 157 million people under age 65.

• Despite employer efforts, millions of Americans already gripped by affordability concerns will face higher deductibles and copays, along with restrictions like pretreatment reviews.

By the numbers: Workers are paying an average of $7,471 this year for family coverage, up 9% from 2025, per KFF's annual survey of more than 1,900 employers.

• Those at firms with fewer than 200 employees are paying an average $9,687 — or $2,847 more than their counterparts at larger companies.
• Total annual premiums for covering a family including the employers' share now average $28,303, up 5% from 2025.
• The average deductible for single coverage is $1,955, compared with $1,886 in 2025.

Yes, but: Premiums have been rising at about the same rate as general inflation and wages over the past five years.

• The average percentage of the premium paid by a worker for family coverage this year is 27%, about the same as in 1999.
• The question is how employers will respond to further increases in drug and hospital spending, more chronic diseases and generally higher demand for health services.

More firms are setting up clinics staffed by clinicians where workers can get care for work-related and other illnesses. The KFF survey found 24% of surveyed firms now have a clinic onsite or nearby.

• Large employers are also increasingly contracting directly with hospitals or health systems to provide care outside of their health plan's network. KFF found the percentage of large firms with such arrangements doubled between 2019 and 2025.
• And employers are varying copays based on the cost and quality of the health providers, to steer workers to those that are more affordable or deliver better outcomes.
• They're bypassing their insurers and pharmacy benefit managers to help workers find lower-cost drugs through third parties like Mark Cuban Cost Plus or GoodRx. KFF found about a third of employers offer workers access to lower-cost mail-order generic drugs.
• They're also looking at giving workers money to access direct-to-consumer programs offering lower-cost GLP-1 drugs.

What we're watching: The remarkably stable labor market continues to give employers reason to insulate workers from some of the worst health price shocks.

• They could still dump more health costs on workers if the labor market softens and there are fewer incentives needed to recruit and retain.

State purges of Medicaid rolls, combined with the expiration of enhanced Affordable Care Act subsidies, helped drive up the share of uninsured working-age Americans to 11.2% this year, compared with 8.9% in 2024, according to a biennial survey out today.

Why it matters: That's even before steep Medicaid cuts from last year's budget reconciliation law and new restrictions on Affordable Care Act marketplace coverage are due to take effect next year.

Driving the news: The Commonwealth Fund survey found the share of U.S. adults with ACA marketplace or other individual-market plans fell from 8.5% in 2024 to 6.4% this year.

• Enrollment in Medicaid fell from 15.5% in 2022 to 13% this year as states resumed eligibility checks that were paused during the pandemic.
• The uninsured rate for young adults ages 19–34 rose from 11% to 16% over the past two years.

Between the lines: The survey of more than 9,300 adults, fielded from May through July, found that nearly a quarter of those who had health coverage over that period had out-of-pocket costs or deductibles that were high relative to their income.

• 31% with workplace insurance were paying off medical bills or debt, as were 33% of those with ACA marketplace or other individual plans.
• Commonwealth officials said that's a concern, because people who skip doctor's visits or drugs because of the cost can turn treatable illnesses into medical emergencies, further stressing the health system.

Commonwealth backs restoring the enhanced ACA premium tax credits, eliminating Medicaid work requirements and increased eligibility checks and establishing a federal coverage option for people in states that have not expanded Medicaid.

What we're watching: Cuts to federal Medicaid spending and new ACA restrictions beginning in 2027 are expected to drive up coverage losses.

• The Congressional Budget Office estimates the uninsured population will grow from 30 million in 2026 to 37 million in 2036, largely due to provisions in the reconciliation law. About 60% of uninsured people in 2036 would be eligible for subsidized coverage.