Annual premium costs for employer-sponsored family health coverage grew far faster than workers' wages and general inflation in 2011, putting even more pressure on workers and employers in a sluggish economy.

The Kaiser Family Foundation's 2011 Employer Health Benefits Survey found premiums rose 9 percent from last year, more than four times the 2.1 percent rise in workers' wages and nearly three times inflation, at 3.2 percent.

"This year's 9 percent increase in premiums is especially painful for workers and employers struggling through a weak economy," foundation president and chief executive officer Drew Altman said in a statement. The foundation is not affiliated with the Kaiser Permanente medical group.

The hikes come after several years of what the foundation called relatively modest increases. Premiums last year, for instance, rose 3 percent.

But since 2001, average premiums for family coverage have swelled by 113 percent to about $15,100, according to the foundation, and the portion that workers pay increased 131 percent. Workers' wages increased 34 percent during the same time frame.

Today, workers pay an average of about $4,100 for annual family coverage and employers nearly $11,000, according to the survey.

"It's troubling, especially in this economy. It's hard for workers and employers to swallow these increases," Anthony Wright, executive director of consumer advocacy group Health Access California, said of the increases.

"Of particular concern is the shift of costs to workers. They're asked to pay more on the front end and the back end with a larger share of premiums and cost-sharing when they get sick," Wright said. "It's the trend we've seen over the last couple of decades. These are decisions that aren't being made in legislatures, but in private boardrooms."

Employers are trying to navigate the new landscape, moving toward lower premium contributions; offering an assortment of high-deductible coverage plans to younger employees; and presenting options including health savings accounts – a rainy-day fund of sorts that allows employees to sock away cash for medical expenses.

"The biggest thing is that a lot of employers are now setting certain amounts they'll contribute," said Doug Bunker, president-elect of the Sacramento-based California Employers Association and owner of River City Staffing in Sacramento.

"One of the last things employers want to cut is employee benefits – that's what keeps (employees) there," Bunker said. "But there's a lot of uncertainty in California and with the national health plan. Employers don't have that luxury anymore."

For employees absorbing pay cuts and higher costs for food and fuel, holding the line on health care has become an increasingly important issue.

In recent days, thousands of nurses and health care workers walked off their jobs in Northern and Central California. The one-day strike was in part to protest management proposals to decrease company contributions to health benefits at Kaiser Permanente and Sutter Health.

In Southern California, three supermarket chains – Albertsons, Ralphs and Vons – ratified a new labor deal after a long fight with grocery workers. The main sticking point: how much employers and workers would contribute to keep alive a health care trust fund for workers.

Health care rates for public-sector employees in California increased this year at about the same rate as the national average for private-sector employees found in the Kaiser Foundation study.

Last year, the California Public Employees' Retirement System approved an average increase of more than 9 percent in health premiums that went into effect in 2011 for its 1.3 million state and local government members and their families.

CalPERS blamed the rate increases on rising costs of health care, medicines and doctors' visits.

Those and other factors continue to drive up health costs, said Patrick Johnston, president of the California Association of Health Plans.

Combined with a bad economy, more employers are dropping insurance or asking employees to pick up a greater share of costs, Johnston said.

He said the underlying issues that drive cost must be addressed and alternative insurance options must be developed. He mentioned health benefit exchanges – such as the one established by the state of California – which allow consumers and small businesses to buy health insurance at competitive rates.

In California, health insurance premiums have been a contentious topic throughout 2011. The state's insurance commissioner, Dave Jones, has repeatedly called for the authority to reject rates his office deems excessive.

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