MICHELE NORRIS, host: From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.
MELISSA BLOCK, host: And I'm Melissa Block. If you're paying more for health insurance this year, you're not alone. An annual survey out today shows premiums for employer policies spiked 9 percent in 2011, and that puts the average cost of a family policy above the $15,000 mark for the first time. NPR's Julie Rovner reports now on the debate over what caused the increase, and what happens next.
JULIE ROVNER: Before we get to the bad news about those higher premiums, there was one bright spot in the survey from the Kaiser Family Foundation and Health Research and Educational Trust.
DREW ALTMAN: There's a health-reform success story here, with the 2.3 million young adults covered on their family policies.
ROVNER: Drew Altman is president and CEO of the Kaiser Family Foundation. He's referring to the results of an early requirement of last year's health law, one that made most employers and insurers allow young adults up to age 26 to get back on their parents' health plans. But requirements like that one have led to accusations that last year's health law is at the heart of the increases. Katie Mahoney is executive director for health policy at the U.S. Chamber of Commerce.
KATIE MAHONEY: There are a lot of benefit mandates and coverage requirements that were prescribed by the health-reform laws. But health insurance, like any product, is a product that right now, we purchase in our country. And if you purchase a car that has leather seats and a sun roof, it's more expensive than an automatic with manual windows.
ROVNER: But with so few of the law's requirements already in effect, Altman says he's confident that the law is not the primary driver of the big increase. He says things like coverage for adult children, and new preventive benefits, are likely only responsible for one or two percentage points at most of the nine percentage point increase.
ALTMAN: We live in a time when those who don't like the health-reform law, they blame everything on what they call Obamacare, including the weather. But no, actually, the increase in premiums we see this year is not primarily a result of health reform.
ROVNER: So what caused the rest? It's only speculation, he says, but it may well have to do with expectations by health insurers that the economy was about to recover, and with that recovery would come a return to a more robust use of medical care.
ALTMAN: So we think they geared their premiums at a higher premium 'cause they thought people were going to start using more health services again. And then they didn't.
ROVNER: Now, there appears to be some evidence that could be the case. Today, the federal government announced premiums for next year for the federal worker health plan. They're going up an average of 3.8 percent next year, or just about half the 2011 increase. Meanwhile, Altman says there's another, more overlooked trend in the survey data: More and more people are being enrolled in so-called high deductible plans, where they have to pay at least a thousand dollars before their health insurance kicks in.
Some of those plans come with special savings accounts to help pay medical bills; some don't.
ALTMAN: I think what's really going on here is just under the radar screen. Without a lot of attention, without any national debate, we're seeing a real revolution in what health insurance is in our country today. So now, we have as many workers enrolled in these high-deductible plans with savings accounts as we have in HMOs.
ROVNER: There's a debate about whether these plans save money by encouraging people to use more appropriate care. Clearly, a major reason employers like them, though, is that they're cheaper. But these plans will be harder for some employers to offer when the rest of the law takes effect in 2014. That bothers opponents like the Chamber of Commerce's Katie Mahoney.
MAHONEY: Our concern is that the new law will take away those choices and harm affordability.
ROVNER: Which leaves the fight over health-care costs still to be solved. Julie Rovner, NPR News, Washington.