They're also refusing to take the insurance, opting instead for cheaper coverage elsewhere. In Kentucky, 20 percent of eligible employees are not enrolled in the state plan, compared to a national average of about 10 percent.

That's not good, experts say.

"If you get your rates too high, the only ones who are going to take it are the ones who are very sick," said William Ashmore, an insurance administrator with the state of Alabama.

That means costs stay high for everybody - including the state - because sick people need more care.

This is just one of many elements in the health-insurance debate, which takes center stage in Frankfort this week. Beginning Tuesday, the General Assembly will convene to address an issue that has prompted statewide protest.

Kentucky workers, including teachers, social workers and state police, pay about 65 percent of family coverage out of their own pockets, compared to 22 percent in other states, surveys show.

Next year, premiums are going up and benefits are being cut even more. In response, school-district employees held marches and demonstrations last Monday, with four Northern Kentucky districts canceling classes.

On Gov. Ernie Fletcher's orders, legislators will gather this week to see what they can do.

It's partly a question of money and priorities. Kentucky has never provided a rich health benefit for employees' families, choosing instead to focus on employees themselves.

For single coverage, the state pays the bulk of the monthly premium, as in other states.

But that's not realistic, said Denise Keathley, a state employee in Grant County.

"This plan is designed for single people who don't have children and are never sick, and that's just not the typical state employee," she said.

This week, legislators will consider boosting employee raises to help cover insurance costs.

Premiums are going up by about 7 percent if employees also accept higher deductibles. If they want to maintain the same level of benefits, they'll have to pay as much as $600 a month for family coverage, up from about $450.

State Rep. Jon Draud, R-Edgewood, said he'd like to help employees by raising Kentucky's tobacco tax - lowest in the nation at 3 cents a pack - to 75 cents. But passage is unlikely because many legislators signed a no-new-tax pledge, Draud said.

Another proposal would give employees an additional raise of $600 next year. The flat amount, as opposed to a percentage, would benefit employees with lower salaries, said Sen. Damon Thayer, R-Georgetown.

He sponsored the bill with Sen. Jack Westwood, R-Crescent Springs.

Their plan also calls for "health reimbursement accounts." The state would deposit $600 a year into the accounts, tax-free, and employees could use the money toward deductibles.

Spending more is the short-term solution. In the long term, states can take various steps to control costs, said Ashmore, executive director of Alabama's State Employee Insurance Board.

Self-insurance is one option, he said.

Most states now assume insurance risks themselves, saving 5 to 10 percent over what they would pay insurance companies, Ashmore said. Under Gov. Fletcher's plan, two of Kentucky's eight regions would be self-insured, but the rest would not.

Wellness programs also are important.

Next year, for the first time, Kentucky state employees will get a break on premiums if they don't smoke.

The state also will cover the cost of preventive care up to $200.

In addition, states can save through regular employee screenings for diabetes, high cholesterol and other problems, Ashmore said.

Alabama started this in the early '90s, "and now we're beginning to reap the benefits," he said.

E-mail kgutierrez@enquirer.com