Healthcare for Small Business


Small businesses are the U.S. economy’s lifeblood, fueling our nation’s growth and prosperity. For too long, America’s job creators have been burdened by escalating healthcare costs threatening their competitiveness, viability, and ability to continue supporting their employees and contributing to their local communities.

For nearly 40 years, NFIB members have identified the cost of health insurance as the number one long-term small business problem.

The status quo is unsustainable, as 98% of small employers offering health insurance are concerned that the cost of providing health insurance to their employees will become unsustainable in the next 5-10 years. Small businesses need relief.

NFIB is committed to advocating for healthcare solutions that empower small employers and their employees with greater choice and control, and access to affordable, flexible, and predictable health insurance options.


Empower small business owners and their employees with greater choice and control.

  • Expand access to tax incentives and tax-preferred Health Savings Accounts.
  • Re-evaluate and right-size current mandates that drive up the cost of health insurance, inhibit job creation, and prevent the implementation of greater mandates.
  • Equalize the tax treatment of health insurance for small business owners and self-employed individuals.
  • Eliminate unnecessary compliance burdens and reporting requirements that impose great administrative costs on small employers.


Increase health insurance coverage options for small businesses so they may provide benefits that best meet their needs and their employees’ needs.

  • Level the playing field between big businesses and small businesses by offering small employers regulatory flexibility and the ability to band together through an Association Health Plan.
  • Improve Americans’ ability to save and pay for health insurance premiums and healthcare costs with tax-favored health accounts such as Health Reimbursement Arrangements.
  • Promote telehealth coverage to increase flexibility, access, and lower costs.


Empower individuals with the ability to choose the coverage that best fits their needs.

  • Protect the employer-sponsored health insurance model.
  • Ensure government-subsidized insurance options do not result in adverse selection or further destabilize the small group and individual health insurance market.
  • Oppose regulations that limit health insurance options.


Promote greater access to quality, affordable healthcare through innovation, transparency, and competition.

  • Promote greater transparency in the healthcare market to empower employers and consumers with the proper information on their healthcare spending.
  • Disincentivize harmful consolidation in local healthcare markets where small employers may already have limited options for providers in their area.
  • Increase transparency in the Pharmacy Benefit Manager (PBM) market to prevent harmful practices that result in higher prescription drug costs.
  • Reduce or eliminate incentives for hospitals to further consolidate and promote transparency in hospital billing.


Anti-competitive behavior and a lack of transparency on the part of Pharmacy Benefit Managers (PBMs) have resulted in significant barriers to affordable healthcare. PBMs have created barriers to competition in the delivery of pharmacy services in community pharmacy settings, resulting in increased costs and reduced choices for small business owners and employees.

NFIB supports reforms to ensure healthy competition and affordability by increasing transparency and ending anti-competitive behavior that harms small businesses and small business pharmacies.

NFIB is a founding member of the Coalition for PBM Reform to engage and amplify the voices of small businesses regarding how PBMs threaten broad and affordable access to local healthcare. The goals of our coalition are:

  • Patient choice of pharmacy
  • Patient access to lowest-cost medications
  • Transparent pharmacy reimbursement
  • Full transparency of true drug costs to employers/plan sponsors


Help us fight for the health of small business

We advocate for issues that have a direct impact on your bottom line. Speak with an NFIB Rep to see how you can help.

NFIB Health Insurance Survey

Share your healthcare story with members of Congress now!


© 2001 - 2024 National Federation of Independent Business. All Rights Reserved. Terms and Conditions | Privacy