Health care costs have risen to $23,215 a year for the typical family of four that gets insurance through work, according to a new report from Milliman Inc., Seattle-based consultants and actuaries.

Although employers pay the largest portion of that health tab at 58 percent (or $13,520) per year, an increasing share of costs has shifted to workers and their families, the Milliman report notes. Workers pay health costs through payroll deductions ($5,908 annually) and out-of-pocket expenses ($3,787).

Health policy analyst Edmund Haislmaier says employees actually end up paying all of the costs because their health plans cut into cash wages.

“If that money wasn’t spent on the employee’s health plan, it would be available for higher wages or more retirement savings,” Haislmaier, a senior research fellow with The Heritage Foundation, told The Foundry.

Health care costs for Americans continue to rise, but the overall annual rate of increase for a family of four is at its lowest since Milliman began calculating costs in 2002. In almost every year for the past 10, the growth rate for family health spending has slowed, the report says.

“That’s because of what’s going on in the way employers and families buy health care and how health care is delivered,” Haislmaier said. “It’s not just fluctuations in the economy or new laws and regulations.”

So far, Milliman finds, “emerging reforms” required by the Affordable Care Act, or Obamacare, have had little direct impact on the cost of care for the typical family of four “because this family tends to be insured through large group plans.”

The report points to a combination of factors, some of which increase health spending, such as specialty drugs, while others decrease health spending, such as cost control measures taken by providers.

However, Obamacare’s upcoming tax on “Cadillac” plans (valued at $27,500 or more for a family of four) will prompt employers to scale back those large group plans to avoid penalties, the report notes.