PROVIDENCE, R.I. ? Rhode Island state employee and single mother Sandra Miller makes $19 an hour. There is not going to be much money left over if she has to start paying for health insurance for herself and her teenage son.

“Even $50 a month is a lot to me,” says Miller, a 47-year-old who interviews applicants for unemployment benefits.

Around the country, Rhode Island and other states struggling with yawning deficits, and rising health care expenses are asking their employees to help pay for their medical insurance or assume a larger share of the burden.

At the beginning of this year, 16 states paid the full cost of health insurance for individual workers, down from 22 in 1998, according to Workplace Economics Inc., a Washington consulting firm. And the number of states offering fully paid family coverage has dropped from nine to six: New Hampshire, New Jersey, North Dakota, Oregon, Pennsylvania and Rhode Island, the firm says.

Kansas costs also are on the rise. Depending on choice of insurance plans and coverage options, Kansas state employees will pay from $9 to $33.50 more per week for family plans and from less than $1 to $14 more per week for individual plans.

Nationally, average monthly premiums for family coverage have risen 64 percent since 1999, according to the National Conference of State Legislatures.

Rhode Island Gov. Don Carcieri, a former corporate executive, wants all 15,000 of the state’s employees to contribute toward their health insurance; currently they pay nothing.

He said his state cannot afford a projected $169 million health insurance bill, double what it was five years ago. Costs have risen in part, he said, because there is no incentive for workers to keep them down.

“If you buy in, then you take ownership and you are concerned about the cost,” he said. “It’s generic drugs versus brand name, going to the accident room at Rhode Island Hospital versus going to the local clinic.”

Sandra Miller is seen outside her home in East Providence, R.I. Miller, a state employee, is concerned with the possibility of paying for health care insurance for her and her son if Rhode Island Gov. Don Carcieri gets his way in having state workers foot part of the bill for their health care.

He has run into opposition from some legislative leaders, who want to preserve lawmakers’ free coverage, and unions.

“States are really in this box,” said Richard Johnson, a vice president for The Segal Co., a New York consulting firm that annually surveys state employee health benefits. “Their budgets are requiring them to find other sources of revenues, or to shift costs, but they’re not giving raises. If they raise employee contributions, (workers say), ‘Wait a minute, you’re penalizing me for working here.”‘

In Wisconsin, wrangling over health care costs helped keep public employees waiting nearly two years for pay raises. They were approved retroactively earlier this year after nonunion employees were required to pay more toward their health coverage.

“Make no bones about it, the era of free health care for public employees is over,” Wisconsin Republican Assembly Speaker John Gard said in May.

Pennsylvania will begin asking some state workers to start paying monthly premiums in 2005.

The debate also has raged in New Hampshire, where a fact-finder recommended maintaining the employees’ current, fully funded health care plan and supported a 5-percent wage increase over two years. Gov. Craig Benson vetoed the idea.

Budget turmoil led Massachusetts lawmakers to increase from 15 percent to 20 percent the health insurance contribution for state workers making $35,000 or more. New employees, regardless of salary, will pay 25 percent.

Other states have resisted the temptation to trim employee health benefits.

New Jersey Gov. James McGreevey instead cut funding for the arts, cultural programs and other services to balance the budget, while freezing wages and hiring.

North Dakota kept its fully paid health coverage for state workers. In exchange, lawmakers did not set aside money for pay increases for two years.

In Rhode Island, Carcieri has started negotiations with workers in the final year of contracts by offering a choice between a cut in pay or a cut in benefits.

“I thought someone was playing a joke on us,” said union local president Michael Downey, a married father of three who has worked as a plumber at the University of Rhode Island for 23 years and makes about $15 an hour.

“It wasn’t the money that brought me to the state and the university,” Downey said. “It was the health benefits.”