WASHINGTON, D.C. (March 11, 2026) – The National Federation of Independent Business (NFIB), the nation’s leading small business advocacy organization, released a new Legislative Health Care Plan outlining several proposals Congress should implement to lower persistently rising health care costs. The proposal is designed to protect and improve small business owners’ ability to offer health benefits to their employees.

“For over 40 years, small business owners have shared how the cost of health care is their number one problem,” said Tyler Dever, NFIB Principal of Federal Government Relations. “They value offering health insurance coverage, and many see it as a critical piece in attracting and retaining employees. However, the U.S. health care system is burdensome, expensive, and cumbersome. Washington continues to push more mandates, regulations and one-size-fits-all policies that fuel industry consolidation, increase costs, and reduce choices for patients. NFIB is urging Congress to confront exploding health care costs by implementing these immediate and targeted policy reforms that will increase flexibility and affordability, and coverage options for small business owners and their employees.”

The proposal highlights 10 legislative solutions to address rising health care costs:

1. Allow small businesses to use health reimbursement arrangements, known as CHOICE Arrangements, that allow customization of health plans.
2. Allow small businesses to pool resources and leverage purchasing power through Association Health Plans (AHPs).
3. Allow health insurance products, like Short-Term, Limited-Duration Insurance (STLDI) plans, to be available for extended time periods.
4. Expand Health Savings Account (HSA) access.
5. Eliminate one-size-fits-all mandates that drive up the cost of care and fuel industry consolidation.
6. Implement site-neutral payments to prevent hospital consolidation.
7. Ban spread pricing and increase Pharmacy Benefit Manager (PBM) transparency.
8. Allow health insurance to be purchased across state lines.
9. Protect small businesses’ access to stop-loss insurance.
10. Increase hospital price transparency so patients know what a procedure costs before insurance pays for it.

View the full proposal here.

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For over 80 years, NFIB has been advocating on behalf of America’s small and independent business owners, both in Washington, D.C., and in all 50 state capitals. NFIB is nonprofit, nonpartisan, and member-driven. Since our founding in 1943, NFIB has been exclusively dedicated to small and independent businesses, and remains so today. For more information, please visit nfib.com.