Since 1999, union's monthly health care premiums have raised an average of 12.58 percent a year, but average wages have gone up only 2.94 percent a year. That reflects a national trend. According to a survey, the annual health insurance premiums provided through the workplace rose 95.8 percent from $6,227 to $12,194. During the same period, the median earnings of California's workers increased just 19.3 percent, from $25,740 to $30,702. For family health coverage, the employer's portion of annual premiums rose 90.9 percent from $4,683 to $8,938. The worker's portion of annual premiums rose 110.8 percent from $1,544 to $3,256.

For years, employers have passed health care costs onto employees, but there's only so much of that employees can bear when wages aren't keeping pace with increases. So the private sector continues to shop around for the best premiums, reduce coverage, or look at alternative models such as paying a lump sum in lieu of benefits, or health savings accounts. HSAs, as they are known, are tax-free investment accounts that can be used to cover medical costs up to a set amount, often the first $1000 or $2,000, after which an insurance policy kicks in. Earnings on investments are tax-free. So are withdrawals for qualified medical expenses.

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