Health care affordability remains a major issue for small businesses. According to an NFIB survey, 98% of small employers offering health insurance are concerned that the cost of providing it to their employees will become unsustainable. NFIB Principal of Federal Government Relations Tyler Dever wrote an opinion article published in Association Health Plans regarding the small business health insurance affordability crisis. 

The small group health insurance market is uneven, and small employers are reaching a breaking point. Participation by issuers is in decline from an average of 13 carriers in 2015 to fewer than five in 2020. This means fewer options and higher prices for America’s job creators. 

“The cost of health insurance has been the top small business concern for nearly 40 years; however, it has become a growing percentage of total operating costs for businesses operating on tight margins,” wrote Dever. “This has disproportionately impacted smaller firms, which pay twice as much for health insurance as their larger counterparts, leading to reduced profits and higher prices.”  

Congress must take action to provide relief for small businesses through legislation like the Association Health Plans Act of 2025 which would promote more flexible, cost-effective plan designs while preserving important consumer protections. 

“Providing small businesses with increased flexibility and options that enable voluntary pooling arrangements is not only good policy but essential to stabilizing a market segment that serves about half of the private U.S. workforce,” explained Dever. “As Congress considers next steps on health reform, affordability and access for small businesses must remain a central focus.” 

Take Action: Tell your small business story about the process of providing health insurance and the impact of the rising costs.