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A growing number of workers in 2009 will pay more for health benefits -- and in some cases receive less coverage -- as their employers grapple with the financial fallout of rising medical expenses and diminished revenue and profits, recent surveys of human resource officials show.

Already struggling in a tough economy, many small employers are about to face another big hit: markedly higher increases in health-insurance premiums as they head into 2009. For many of these companies, the steeper increases couldn't come at a worse time, when the economy is weakening and credit is harder to come by.