Going against the trend of making workers pay more for their health care, the Texas Association of Health Underwriters is expected today to call for a change in state insurance law that provide for plans requiring employers to pay 100 percent of employee insurance premiums.

If employees didn't have to pay any part of the premiums, the association argues, all would sign up for health insurance. And that, it says, would drive down the per-employee cost of premiums by 7 percent to 10 percent.

Premiums at Dallas-Fort Worth businesses averaged $9,021 per employee in 2007, up 7.6 percent from 2006, according to Hewitt Associates LLC, a human resources consultant based in Lincolnshire, Ill. The national average was $8,340, up 7.7 percent from 2006.

Local business leaders were not all enamored of the new plan. Some questioned the logic, saying it would instead put unneeded financial pressure on employers and ultimately reduce workers' salaries.

What is certain is that the state does have a problem with uninsured residents – the percentage without health insurance here is the highest in the nation, according to the Texas Medical Association.

In a state with 23.5 million people, more than 5.5 million lack insurance, the TMA reports.

Two-thirds of the uninsured in Texas are working adults who don't have access to an employer-sponsored plan because their employer either doesn't offer it or workers can't afford the premiums, according to a January report from the state's Legislative Budget Board. About 44 percent of those working uninsured are at companies with fewer than 25 employees, said Carolyn Goodwin, president of the Texas Association of Health Underwriters.

"Our initiative is aimed squarely at the small-employer marketplace," Ms. Goodwin said. "While it's not the cure-all for everything that's wrong, it offers a major opportunity to bring insurance to many, many Texans who don't have it today."

Because of high premiums, healthy workers are not signing up for health insurance, Ms. Goodwin said. Such workers are needed in group plans to offset the cost of sick workers.

Current insurance code in Texas does not permit plans requiring employers to bear the full expense of premiums for their workers, so employees must pay a portion, usually through payroll deductions.

If insurance carriers are given the flexibility to design plans with premiums paid entirely by the employer, the association believes, they could offer significantly lower premiums per employee.

"In other words," Ms. Goodwin said, "we would be rewarding better rates to employers who pay 100 percent of the employee premium."

Such a plan could backfire, said Marianne Fazen, president of the Dallas Fort Worth Business Group on Health. She questions whether the expected drop in rates would be enough to justify paying all the premiums.

Lower salaries would probably be the result, Ms. Fazen said, because employers would have less money for raises.

A better plan, she said, would be to allow small employers to band together and buy one group plan in order to spread the risk broadly.

Or, she said, workers who bought their own health coverage could be given a tax deduction or tax credit much like the one that employers now receive.

The trend in health care is for employees to pay more – not less – of their health care costs, Ms. Fazen pointed out.

Under "consumer-driven health care," employers shift costs to workers with the rationale that employees will spend more wisely if it is their own money.

"Right now, there's a cost-sharing strategy with employees for them to contribute more, put more skin in the game," she said.

In May, Tom Emerick, vice president of employee benefits at Wal-Mart Stores Inc., spoke to Dallas-Fort Worth executives and benefit managers about the rewards of high-deductible health plans, which require the insured to pay more of their health costs before insurance coverage begins. Wal-Mart, which employs 1.3 million in the United States, offers workers plans with deductibles ranging from $350 to $1,000, as well as ultra-high-deductible plans of up to $6,000.

"The greatest incentive for health and wellness is high deductibles," Mr. Emerick said during his appearance before the Dallas Fort Worth Business Group on Health.

A spokesman for the Texas Association of Health Underwriters said having employers pay 100 percent of the premiums would not rule out also having high deductibles. It's unknown whether workers would sign up for a free-premium plan that they couldn't afford to use because of the high out-of-pocket expense.