Counties offer extensive employee health coverage.

America's counties spend an estimated $20 billion to $24 billion on health insurance premiums each year, covering an estimated 2.5 million county employees and nearly 2.4 million dependents, according to a new study by the National Association of Counties. The report, titled County Health Benefits 2014, examines changes in health benefits coverage, cost-containment strategies, trends in wellness programs, coverage for retirees, and implementation of the Affordable Care Act.

Survey results include the following.

* County health benefit eligibility for employees and dependents and county spending on health insurance increased significantly over the last five years. Between 2009 and 2014, average monthly premiums for county health plans increased by 20 percent. In addition, counties that offer coverage to all of their part-time employees doubled (from eight to 16 percent). PPO plans are the most popular plans; more than 70 percent of respondents offer one. Nearly 30 percent offer an HMO or EPO plan, and 31 percent offer a high deductible plan. HD plans have experienced more growth than any other type of plan over the past five years, up 21 percent in 2009.

* Counties are working with their employees to contain health-care costs, by continuing to share premium costs or increasing the deductible amounts, copayments or out-of-pockets limits. Deductibles have risen dramatically between 2009 and 2014, by an average of 49 percent for single coverage and 67 percent for family coverage. Employee copayments also increased during this period by 19 percent for HMO/EPO plans and by 13 percent for PPOs. Out-of-pocket maximums increased by an average of 59 percent over the past five years. Out-of-pocket rates have increased faster for HMO/EPO plans than for any other type, with maximums...