Employers, by law, are not required to offer benefits at all (temp services come to mind), and I’ve had the misfortune of working for companies that offer no insurance at all.
Health insurance premiums are determined by a complicated formula based on what kinds of benefits are to be offered (i.e. preventive and emergency care only is much cheaper than comprehensive coverage), how many people are going to be covered (Joe’s Diner with ten employees is more expensive than, say, IBM with thousands or tens of thousands of employees.), what the employer’s contribution is going to be (some companies I’ve worked for have paid all of my premiums; others, and the federal government is notorious for this, have cost an arm and a leg). Requiring a deductible knocks costs down by making the employee pay for a significant share of the year’s initial costs.
The point of this explanation is that many companies, especially those which employ a small number or a number of low-wage-earners, choose not to offer insurance benefits at all.