If you’re a typical American worker, or if you manage one or more of them, you’ve spent the better part of 2009 dodging layoffs, buyouts, furloughs, salary cuts and other reductions. No big surprise there.

Given all of that, you also shouldn’t be surprised at this: Your employer-sponsored benefit packages next year are going to hit you with more out-of-pocket expenses, a bigger push for wellness, fewer choices and options, and tighter cost controls.

This is what benefits experts at Watson Wyatt Worldwide, a leading global consulting firm, have identified as trends that employees can expect to see in their 2010 benefit packages during their open enrollment period this fall. According to Watson Wyatt, these include:

• Higher out-of-pocket costs. More than four in 10 employers in a recent Watson Wyatt survey said they will raise deductibles, co-payments and out-of-pocket maximums due to the economic crisis. Some employers might raise doctor visit co-payments by $5. Others might no longer provide 100 percent coverage for in-network services, opting instead to introduce some level of co-insurance to encourage workers to be more aware of the cost of services. Deductibles for individual and family coverage are expected to increase by $50 to $100 or more among some employers.

• Greater use of incentives to stay healthy. Employers are continuing their push to improve the health of employees and their families. In addition to continuing the focus on wellness communication, employers are offering workers (and, in some cases, spouses) more incentives such as gift cards, cash and discounted premiums for undergoing a health risk assessment or participating in smoking cessation, weight management or fitness programs. They are also giving workers access to on-site health coaching as well as using health service providers to deliver Web-based and telephonic coaching.

• Consumer-directed health plans. More employers will offer CDHPs next year as they are increasingly viewed as an effective way to control rising costs. Those employers adopting new plans are generally adding a high-deductible plan, often with a health savings account. Most employers adding these plans will offer them as an option to workers rather than replacing their traditional health plans.

• Consolidation of health plan offerings. Some employers plan to reduce the number of health plan options they offer to workers. As more employers consolidate and change their health plans and networks for 2010, some employees might have to change physicians or pay higher out-of-network costs.

• Prescription drug benefits. Some workers will see changes to their prescription drug benefits in 2010. As part of an overall movement to CDHPs, a number of employers are introducing a CDHP prescription drug benefit option that typically offers workers 100 percent coverage on a list of preventive medications. Other companies are introducing value-based designs that include zero co-pays on certain prescription drug therapies that are known to help lower health costs and reduce hospitalizations.

• A closer eye on spousal and dependent coverage. Employers are increasingly revisiting spousal and dependent coverage in their efforts to control rising costs. Some employers are requiring spouses to complete health-risk assessments, while others are charging higher premiums for working spouses who have access to other health care coverage. More employers are also expected to audit their workers to eliminate dependents who are not eligible for coverage.

With health care costs expected to rise 10.5 percent in 2010, slightly more than the 10.6 percent forecast increase in 2009, it’s not surprising that employers continue to tighten up on the cost and management of benefit programs. That’s because double-digit increases in health care and other benefit costs are just not sustainable for anyone. Even the most generous organization is going to need to find some way to spread these increases among everyone getting the benefits.

Watson Wyatt senior consultant Tom Billet says these benefit plan changes for 2010 are due to the “uncertain economy and rising health care costs that show few signs of slowing.” Of course, that’s at the core of the national debate on health care reform too.

If anything is clear in all of this, it’s that the unrelenting double-digit increase in the cost of health care will continue to affect everyone—both employers and employees—no matter how you feel about the reform efforts coming out of Washington. And, it’s why the debate on the subject isn’t likely to be solved anytime soon.

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We’ve written a lot about wellness initiatives here at Workforce Management—those programs that some companies pay for to help workers get healthier. But the big question always comes down to this: Do they actually help organizations save on their overall health care costs?

Getting a handle on the ROI of any wellness program is always tough, and often the answer comes down to: “Yes, we know it is making our employees healthier, but we can’t really tell you how much we’re saving.”

That’s why I was intrigued by this story in Florida’s St. Petersburg Times about how a lot of businesses in the Tampa Bay area are not only investing in wellness but also have some ROI they can point to as well.

“The Tampa-based Employers Health Coalition,” the newspaper reported, found “that wellness programs saved money and improved productivity by 34 percent, [and] a 2007 American Heart Association survey found that employees in companies that encouraged healthy habits used fewer sick days, had greater job satisfaction and did better work.”

One company, Pepin Distributing Co., opted to cover the $1,800 to $2,000 per person cost of a program that would help encourage weight loss and prevent or reduce complications of obesity such as heart disease and diabetes.

“The plan is considerably more expensive than programs such as Weight Watchers, which some employers offer,” the newspaper noted. “But if Pepin participants gain back the weight within a year after finishing the program, they must reimburse the company in full.”

Here’s the kicker to all of this: “Pepin spends more than $2 million annually on health care for its more than 300 employees. The company expects to see a return of $3 to $4 on every $1 spent on the weight-loss program.”

I was surprised by two things here: the amount of Pepin’s investment ($2 million annually is a LOT of money) and the 3-1 or 4-1 ROI that the company reported. I don’t watch this closely, but I can’t recall seeing a return on investment like that from a wellness program anywhere.

This says to me that positive wellness programs focused on helping workers take better care of themselves can have a positive impact on both the workers and on the organization’s bottom line. And, they make more sense than some of those punitive, punishment-based programs that a few businesses have.

The bottom line, as you know from the highly charged national debate that’s going on right now, is that health care is a huge drain on a company’s bottom line. A smart and well-constructed wellness program, like the one at Tampa’s Pepin Distributing, can be just one more tool that smart-thinking managers can use to get a better handle on health costs while also doing something that will lead to healthier, more fully engaged employees.

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Motivating workers to get healthy is a tricky business.

Anyone who manages people these days knows that there is a tremendous effort by a lot of organizations to get employees to take better care of themselves and ultimately save the company money through lowered health care costs.

No one has quite figured out the perfect approach to this, so businesses bounce from encouraging healthier practices by essentially bribing workers with a cash incentive, to taking a punitive approach by threatening to charge those who smoke, or even resorting to not hiring people who say they smoke.

This all raises a reasonable question: Just what does it cost to get workers to quit smoking and stay healthy, anyway?

And, here’s the answer, according to the New England Journal of Medicine and reported by the Associated Press—it costs $ 750, if you believe a study of workers conducted by General Electric since 2005.

“Among those paid up to $750 to quit and stay off cigarettes, 15 percent were still tobacco-free about a year later,” according to the AP story published in the Fort Worth Star Telegram. “That may not sound like much, but it’s three times the success rate of a comparison group that got no such bonuses. GE was so impressed that it plans to offer an incentive program nationwide next year, aiming to save some of the company’s estimated $50 million annually in extra health and other costs for employees who smoke.”

This all sounds good, but I wonder: Will financial incentives to help workers stop smoking or work harder to stay healthy be a line item that avoids getting whacked out of the budget during these tough times? Yes, you can point to a pretty nice ROI in the GE study, but how many organizations will really look at it that way and not just focus on the upfront dollars it takes to encourage the cost-saving behavior?

Our friends over at the Benefits Buzz blog made this very point recently when they penciled out the costs for corporate gym or health club memberships for employees based on a 2005 study that found most people who pay for gym memberships only work out there four—yes, four—times per month.

“Each attendee’s four trips per month to make a trip to the sauna and catch up on sitcoms as they gingerly touch the pedals of a recumbent bike is never, never, ever going to make a dent in your health care or absenteeism costs,” the blog post noted. “I don’t care what anyone else tells you.”

In my book, it’s worthwhile to pay smokers to quit because it ultimately will help the organization make a big dent in health care costs, as GE has found. My guess, however, is financial incentives like this one will face the budget knife in most companies this year.

It’s not that organizations don’t see the benefit in helping employees to get healthy. I think they do. But the issue for many will be a lack of focus on the long-term ROI when the more pressing issue is just keeping things going through this terribly difficult year.

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I get a fair amount of reader feedback to this blog—and I thank you all for that—but some of the things I write seem to resonate more deeply than others. I’m not always sure just why people want to comment on certain topics or what gets them riled up, but I’m grateful for all the feedback nonetheless.

And, as I noted last week when I wrote about the top-selling books for the year from SHRM, there is probably some message in this list of my Top 10 most commented-on blog items here at the Business of Management, although honestly, I’ll be damned if I can figure it out. Can you? Here’s my Top 10 list from 2008:

1. Verbal Abuse as a Workforce Strategy (March 7). Reader comment: “Among employment attorneys, there is often talk of the so-called ‘equal opportunity jerk.’ No one is defending a manager or management style like this. It’s just that the company’s legal team doubtless looked at a tough fact situation and determined that the best strategy was to point out that the plaintiff was not singled out for bad treatment—everyone suffered more or less the same. Rest assured—eventually the company will have to reform its work environment, or else the turnover, morale and productivity problems will drag it down.”

2. Bosses Behaving Badly (January 18). Reader comment: “What is amazing to me about these crazy bosses is that we the citizens of this planet allow them to continue their bad behavior and go to great extremes to win their favor.”

3. Good Manners Never Go Out of Style (December 2). Reader comment: “Thank-you notes are a sign of class in a world where reality shows spew foul-language bleeps more often than dialogue. Thank-you notes are a sign of consideration in a world where people are shot for looking the wrong way at the wrong time. Thank-you notes are a message of respect in a world that values a bargain more than a human life.”

4. From the Editor: Why We’re Writing About SHRM (February 3). Reader comment: “SHRM has a purpose and serves a mission, just not the one that they put in writing. Where SHRM goes wrong is when they indicate that they represent a profession. The reality is they represent a large group of people that may or may not be HR professionals, but that do work in or with some HR functions.”

5. Is There Ever a Good Time to Fire Someone? (June 17). Reader comment: “Why does everyone assume that whenever anyone is fired they will either: a) go postal, shoot all their workmates and then take the server down (so don’t fire them early in the week); or b) go home, drink their drink cabinet dry and then start in on the medicine cabinet (so don’t fire them on Friday). Honestly, how many times has this really happened?”

6. Demanding That Workers Take a Vacation—or Else— (March 14)

7. Does Managing by Fear Ever Work? (August 14)

8. Delighting in Layoffs: A Sure Ticket to Management Hell (July 31)

9. Charging Workers for Smoking? Uh, Never Mind … (April 23)

10. Law or No Law, Pot Smokers Can Get Canned in California (January 25)

Let me be clear about this: I don’t smoke, I have never smoked, and I have serious questions about people who, in this day and age, continue to smoke despite years of warnings about all the bad things that tobacco does to your body.

But I don’t agree with the misguided notion that passive smoke is some sort of crime against humanity. As a nonsmoker, I don’t like smoke in my face but I also don’t think it’s fair that our nanny society seems to want to treat smokers like they’re lepers by making it harder for them to find a place to puff.

I find the over-the-top anti-smoking zealots to be far worse for my health than any passive smoke I might run into. Their holier-than-thou rhetoric and action increases my blood pressure, and it fails to recognize the basic principle of dealing with humans: We’re human. Stopping smoking is tough for even the most motivated person to follow through with, and I am reminded of my winters in Great Falls, Montana, when the smokers congregated for a puff outside the back door of the newspaper in 15-below temperatures. Think they would be out there freezing to death if quitting was all that easy?

The push to get smokers to quit has changed over the years, and the newest trick is also the most insidious: Don’t hire smokers. We’ve reported on this in Workforce Management, but what started with a trickle of organizations taking this approach is now spreading, as this story from The Cincinnati Enquirer seems to indicate.

Although most companies still try to use smoking-cessation programs as the way to get employees healthier, Cincinnati-based USI, an insurance and financial services company, now tests new employees when they’re hired. If you smoke and show no signs of trying to stop, you don’t get the job.

“We decided not to hire smokers because they add additional expense to our health plan and our ongoing operation,” said Dennis Curran, chief human resources officer for USI’s Midwestern region.

The Enquirer story points to a USI job candidate by the name of Jamie Holleman. She had applied for a commercial lines account manager position, “interviewed in March, then withdrew as a job candidate after it became clear that the smoking policy would be an obstacle. But the company called again in July and asked if she would enter a smoking-cessation class. She now takes weekly classes at St. Luke Hospital. ‘I was shocked,’ Holleman said of her reaction when she first heard USI’s position. ‘But I had actually been talking to a friend of mine about quitting.’ ”

Here’s an interesting side element to this story: Although you can deny a smoker a job in Cincinnati, it’s illegal to do so across the Ohio River in the tobacco-growing commonwealth of Kentucky.

The Bluegrass State considers smokers to be a protected class and according to The Enquirer, “a law on the books for several decades in Kentucky, one of the nation’s leading tobacco-growing states, says it would be illegal for an employer ‘to require as a condition of employment that any employee or applicant for employment abstain from smoking or using tobacco products outside the course of employment, as long as the person complies with any workplace policy concerning smoking.’ ”

The story also points to another issue in this debate: that the laws about using workplace hiring policies to regulate behavior such as smoking are evolving. “Courts haven’t quite figured out what to do with it,” Justin Flamm, a partner at Taft, Stettinius & Hollister, told the newspaper.

If you’re like me and feel that the anti-smoking zealots have run amok and gone too far, perhaps the better approach is the one most sensible companies follow: Encourage workers to do whatever they can to take better care of their health, whether it be losing weight, exercising more or giving up the smoking habit.

Some companies have even gone so far as to offer financial encouragement to workers who try to get healthier. That’s certainly a more sensible approach and one that is more likely to work. In my many years of management experience, policies that punish people for all-too-human behavior are doomed to fail. That’s something I wish the anti-smoking zealots would remember. You get more positive action by encouraging people to change their ways than you do by wasting brain cells in pursuit of new ways to punish them.