Slow growth seems to be the new norm for health care. As we reported last month, overall health care spending grew by 3.6 percent in 2013, the slowest rate of growth since 1960. A Commonwealth Fund study released this morning shows that employer-sponsored health insurance premiums grew more slowly in 31 states between 2010 and 2013. The findings echo a Kaiser Family Foundation report issued last fall.

However, and this is a big however, the Commonwealth study found that out-of-pocket expenses for workers continue to grow at a troubling rate. Nationally, out-of-pocket costs were 9.3 percent of median household income in 2013, compared with 5.3 percent in 2003.

That’s because premiums and increases in deductibles are outpacing wages. Between 2003 and 2013, per person deductibles nearly doubled in all but six states. Back in 2003, no state had an average deductible exceeding $1,000. In 2013, all but three states and Washington, D.C., had deductibles of $1,000 or more.

“High deductibles are now the rule rather than the exception,” Cathy Schoen, executive director, of Commonwealth’s council of economic advisers, said on a press call yesterday. She added that 82 percent of people 65 and younger live in states where total premiums (employer and employee share) exceed 20 percent of median incomes.

Short term, the higher out-of-pocket costs could lead people to hold off on or avoid medical care, Commonwealth President David Blumenthal, M.D., suggested during the press call. Long term, “keeping premium growth in check without eroding benefits” will require “concerted efforts” by the public and private sectors, the report concludes.