Higher premiums plus higher out-of-pocket costs for health care are putting working families’ budgets under stress across the country, a new report from the Commonwealth Fund, New York, asserts.

Premiums for employer-sponsored family health insurance increased an average of 41% across states from 2003 to 2009, according to a study by the Fund. That rate was more than three times faster than rises in median incomes, the study report points out.

At the same time, insurance appears to be buying less. Deductibles per person rose 77% on average, the Fund found.

If premium costs continue to rise at the pace seen from 2003 to 2009, annual premiums would increase by 79% percent, to an average of $23,342 per family by 2020, according to the report.

If reforms under the Affordable Care Act slow historic premium increases by 1% per year, annual family premiums would be $2,323 lower by 2020, the report projects. Slowing premium growth by 1.5% per year would yield $3,403 in premium savings through payment incentives and delivery system improvements.

The Fund’s analysis of state trends from 2003 to 2009 found employer-based premiums for family coverage increased an average 41% across states, with increases ranging from 21% in Delaware to 59% in Louisiana.

By 2009, premiums were highest in Alaska, Connecticut, Massachusetts, Vermont, Wisconsin and Wyoming, with family premiums in those states exceeding $14,000 a year, the report found. Even in the lowest cost states–Alabama, Arkansas, Hawaii, Idaho, Kansas, Montana, North Dakota, Ohio, Oklahoma, South Dakota and Utah– annual family premiums ranged from $11,000 to $12,000 per year by 2009.

At the same time, deductibles rose sharply in almost all states, increasing an average of 77% from 2003 to 2009 in large as well as small firms. In addition, more workers paid deductibles–74% in 2009, compared to 52% percent in 2003.

Data for premiums and deductibles came from a survey of employers. State median incomes were from the U.S. Census Bureau.

-Trevor Thomas