In April, business executive Clay Morgan found his family's health insurance in limbo after he moved across state lines from Kentucky to Nashville. Merely updating his address with his carrier wound up pushing him into a different, much more expensive plan.

"My wife was three weeks pregnant — just barely," Morgan said. "I was floored, absolutely livid about it."

All of a sudden, he had to examine his insurance options more closely than he ever had before.

Families across the country are experiencing a similar phenomenon as companies roll out their enrollments benefits packages this fall. Companies are bracing for the impact of the Affordable Care Act, and many are changing the health benefits they offer employees. That probably means that they are accelerating the trend of transferring more of the cost of care onto their workers. Employees, many who have been thrust into the role of health care consumer for the first time, are struggling to decide what to do.

Most American workers get insurance through their employers, according to a recent study by the National Institute for Health Care Management. As of 2011, the study said, more than half of the 75 million non-elderly people with jobs in the private sector were insured through firms with more than 500 employees. One quarter were insured through firms with 50 or fewer people on staff.

The cost of insuring the majority of the American workforce doesn't come cheap. Health insurance costs ate 7.7 percent of total payroll expenses for private-sector employers in 2012, according to the NIHM study.

It's a high cost that companies have long wanted to shed. And in the wake of health reform, they are taking action. Over the next four years, the study said, 69 percent of employers plan to shift more of the cost of health care onto employees. In real terms, that can mean much higher premiums for people, especially for employees trying to get coverage for their families.

In 2013, individuals paid, on average, $5,900 in total annual premiums for employer-sponsored coverage. On average, family plans cost more than $16,300. "With employees' costs for medical coverage growing much more quickly than general inflation, hourly earnings and family income, some workers are inevitably (being) priced out of coverage," the study said.

Eventually, the type of coverage will change, too. The NIHM predicts that by 2018, 40 million American employees will be enrolled in private exchanges. In this model, employers may give employees a set amount to help buy health coverage. The company will offer a selection of plans that workers can choose from. If they choose a plan that is more expensive than the employer's contribution, the employee must pay the difference.

By comparison, the study estimates 31 million members of the workforce will get their insurance through the federal health exchange by 2018.

In the interim, however, companies and the people they employ are struggling to navigate an uncertain system. The ACA does not offer much of a roadmap. It does mandate that companies with more than 50 people insure employees. Those that don't will face fines. Originally scheduled to go into effect Jan. 1, that tax has been delayed until 2015 to give employers more time to comply.

A scapegoat?

But a funny thing happened: With the government mandating that employers provide coverage for employees or face penalties, many companies began to deeply research the policies they offer and trim what they don't have to provide.

One of the big items on many a chopping block is coverage for spouses, for instance.

"As businesses try to shave expenses, there's no getting around it, this is a very expensive area of health care," said Brian Haile, senior vice president for health policy at Jackson Hewitt. "The question is, is that practice becoming more prevalent? Absolutely. Did the ACA accelerate that practice? Arguably yes. The ACA may have rolled it forward a year or two, but that was on the horizon.

"It's not an accident that employers who are increasing the cost for workers are blaming Obamacare," Haile said. "It's a very convenient scapegoat."

Employers aren't necessarily using that scapegoat to be nefarious, Haile added — they're confused, too.

"The challenge we're seeing right now during open enrollment season, for employers, is that they're trying to make the right decision about what's in the best interest of their employees and the company," said Austin Madison, vice president at Nashville insurer Crichton Group. But now, he says, "It's kind of like death by information overload."

With employers frozen, the onus is on the individual to act, which is easier said than done.

Morgan, for example, is a small-business owner. He runs a local office for BNI, the world's largest business networking organization. For several years, he's bought insurance without an employer in between. But moving to Nashville wiped his family's coverage record with his carrier, and, like employees across the country, he was faced with the option of starting over.

"Any time you're dealing with something that has to do with health, potentially life and death, and there's a lot of money on the line, and you don't have a frame of reference, it makes it very challenging to figure out what to do," Morgan said. "And we just had more questions than we had answers."

The big reveal

Americans aren't confused about buying health insurance because they are lazy — for decades, they've been protected from the true cost of care, which has spiraled dramatically.

The history of American health insurance is a history lesson about taxes, Alex Tolbert, founder of local company Bernard Health, explained to health care industry up-and-comers last month.

After World War II, the government was concerned about wages skyrocketing unsustainably as companies bid to get the best employees, Tolbert told the group. But companies, ever brilliant about finding loopholes, began offering benefits, such as paying for health insurance.

Then, in 1954, Congress passed a law including the provision that employers could contribute to employees' health insurance tax-free. Ever since, employers and insurers have negotiated benefits, largely without employees watching.

Now, the blindfold is being ripped off.

"I've probably had three different insurance carriers since I started working," Morgan said. "I've never thought about it to this extent. I haven't been that concerned about it. You've got the coverage, you know what you're paying, you know roughly what it includes, and you just kind of go about your life. Your life isn't insurance; your life is living."

But now, Morgan and the rest of us are taking part in the big reveal. Americans were supposed to become informed health care consumers as part of the rollout of the federal exchange, or healthcare.gov. However, the government-run Web platform is glitchy, when accessible at all.

That's a major problem as families consider new ways to balance coverage with cost. If employers are raising the price of coverage for families, the best option for some employees may be to sign up for individual coverage and shop for other family members on the exchange — or it would be, if the exchange ran smoothly.

Do the research

In the short term, there's no easy answer, said Crichton Group's Austin Madison.

"This year is going to be rocky, and I think next year is going to be rocky," he said.

"If there's a takeaway, both to employers and consumers, it's that at the end of the day, you've got to make sure you're informed. It's like if you're going through an election — you've got to do the research to figure out what's actually going on."

In Morgan's case, he sought advice from Tolbert's firm. Morgan ultimately put himself and his 2-year-old daughter on a BlueCross BlueShield family plan. His wife is on a high-deductible individual plan. The family also opened a Health Savings Account, in which they can put aside the money they save toward her maternity care.

"We have a follow-up appointment to re-evaluate a little bit before Thanksgiving, once pricing is known about the exchange," Morgan said. "Will we go to the health care exchange? Will we stay where we are and merge everybody on the family plan once the baby's here? We don't know."

Nobody really knows. Every family has different circumstances, and different possible outcomes.

"When it's the biggest problem you have, that's a blessing," Morgan said. "But it doesn't make it easy, and it shouldn't be that complicated."

Contact Shelley DuBois at 615-259-8241 orsdubois@tennessean.com. Follow her on Twitter @shelleydubois.

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