Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments. For many people, their coverage may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits now take a back seat to basic expenses like food and gasoline.