The health care cost trend appears to be heading up again.

According to a recent survey of 400 employers by BLR, 42% are bracing for health care cost hikes exceeding 10% in 2009. Another 9% of the respondents said they expect costs to rise 9% this year. Only 13% anticipate no increase.

The BLR survey results are in line with some forecasts for 2009, while others predict a slightly lower increase in costs. A Buck Consultants survey supported the 10% increase, as did an Aon Consulting Worldwide survey which found a 10.5% increase in costs. Hewitt Associates and Mercer predicted lower increases (6.4% and 5.7%, respectively).

According to a recent Mercer study, employers are continuing to turn to high-deductible plans with an HSA or HRA to help offset rising costs in 2009. Among those who currently offer such consumer-driven health plans, experts predict a cost increase average of 4.5% as compared to a rise of 6.4% for companies not offering a CDHP.

In 2007, Mercer reported that 52% of employers were already promoting consumer-directed health plans (CDHP) with 62% citing the strategy as successful. Of those employers offering a CDHP plan in 2007, 44% offered employee controlled health savings account (HSA) with 52% very likely to start offering HSAs in 2008. Twenty-nine percent offered health reimbursement arrangements (HRA) in 2007 and 38% were likely to offer the plan the following year.

"This opportunity for saving is good news for employers committed to offering health coverage," Blaine Bos, a senior Mercer health and benefits consultant based in Minneapolis, says. "But even though CDHPs cost about 20% less than a typical medical plan, the percentage of very small employers providing employee coverage keeps shrinking. This is one of the leading causes of the increase in the number of uninsured over the past few years, and a troublesome finding for policymakers who were counting on these plans - specifically HSAs - to reverse the trend."