The rising cost of health insurance is at the center of Congress' debate over health care reform. The question for lawmakers, however, is what reform actually lowers costs without adding to the deficit or impacting quality of care.

Thursday's announcement by Senate Majority Leader Harry Reid (D-Nev.) that the issue will not come up for a vote before the month-long recess was seen by some as a stumbling block -- but others said that lawmakers will get an earful from their constituents as they make the obligatory round of fairs, picnics and festivals in their home districts.

The cost of insuring a family of four with an employer-sponsored health plan in the United States averaged $12,298 in 2008, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. In most cases, employers and employees shared the cost. Another study found that small businesses are being crushed by health care costs.

The federal agency's new data for private industry further showed that the annual premium for covering an employee and one family member, known as an "employee-plus-one" plan, averaged $8,535, while the annual premium for a plan that only covered the employee averaged $4,386.

Almost 20 million of the 62.5 million workers enrolled in employer-based insurance in 2008 had family plans, while about 11 million had employee-plus-one plans. The 31.5 million remaining workers had single-coverage plans.

AHRQ's 2008 private-industry data also showed that:

• Nationally, workers enrolled in family plans last year contributed an average of $3,394 toward the cost of their premiums, compared with $2,303 for an employee-plus-one policy and $882 for a single-coverage plan.

• Across all states, workers in Florida contributed the most for a family plan ($4,412) while Indiana workers contributed the least ($2,472); for employee-plus one plans New Hampshire workers contributed the most and Idaho workers the least ($3,005 and $1,736 respectively); and for single coverage, New Hampshire workers again contributed the most ($1,264), and workers in Hawaii contributed the least ($451).

• For about 22 percent of workers with single-coverage plans, their employers paid the entire premium amount. In contrast, employers paid the entire premiums for just 11 percent of workers with family plans and 9 percent of those with employee-plus-one plans.

Small business

It's not just individuals who are likely to be buttonholing their Congressional representatives in August. Small business owners are being crushed by rising health care costs, and feel left out of the current health care debate in Washington, according to a new report released by U.S. Public Interest Research Group.

"In this economy," said U.S. PIRG's Health Care Advocate, Larry McNeely, "health care costs are killing small business owners. But instead of leading on this important issue, the national Chamber of Commerce and other inside-the-beltway groups are playing politics with a crucial issue and actively impeding reform efforts."

The new report, The Small Business Dilemma, which surveyed hundreds of small business owners and managers across the country, makes clear that small business owners want and need health care reform.

Mike Brey, owner of the Hobby Works hobby stores located in communities around Washington, is one of those small businessmen, and he is eager to speak out on the issue.

"We are creating a greater downward spiral," Brey said about the current health care system and its rising costs.

U.S. PIRG surveyed 309 small business owners and managers around the country for the snapshot survey. The data collected found that the costs and administrative hassles associated with offering insurance weigh particularly heavily on small businesses.

According to the 14-page report:

• Small businesses value health insurance as a key to business success because it allows them to attract better employees.

• 78% of small business owners surveyed who do not offer coverage would like to do so.

• 80% of those who would like to offer coverage cite the expense of coverage as a reason why they don't.

William Dennis, a senior research fellow with the National Federation of Independent Business Research Foundation tells that the U.S. PIRG findings complement what his surveys show. "Health care," he says, "is a major cost item" for small business.

Dennis agrees that small business has traditionally been left out of the health care debate, but notes that "this time it's much better. At least we're getting some consideration."

Recent analysis by MIT Professor Jonathan Gruber, commissioned by the Small Business Majority, found that health reform would save up to 128,000 small business jobs that would otherwise be lost due to high health care costs.

Achieving these benefits will require ensuring that health reform legislation has a mix of policies that work for small businesses, according to the study, including health insurance exchanges, ending discrimination in issuance, renewal, and pricing of coverage plans based on health history, small business tax credits, and a comprehensive push to reduce the growth in overall health care spending.

As Dennis puts it, "Everyone agrees that change is needed. The big question is 'how do you do it?'"