Small Business Owners’ No. 1 Problem: The Rising Cost of Health Insurance
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Health insurance has become one of the most difficult and expensive challenges facing employers, including print service providers that already operate on narrow margins. After payroll, health insurance is one of the biggest expenses for small businesses, and the latest data shows that these costs are accelerating at a pace that is simply unsustainable. The average cost of a healthcare premium for small business owners has risen by more than 120% since 2000.
Because nearly all U.S. printing businesses qualify as small—with estimates of 35,810 establishments with fewer than 500 employees—the sharp rise in health insurance costs disproportionately strains our industry’s employers, limiting their ability to hire, retain workers, and invest in growth. Not surprisingly, the cost of providing health coverage to employees looms larger the smaller the business, but this issue plagues businesses regardless of size.
For companies with 10 to 199 workers, the average family premium for employer-sponsored coverage climbed to $26,054 in 2025, up from $16,977 in 2020, a staggering jump of more than 50% in just five years, according to a recent KFF report (KFF was formerly known as the Kaiser Family Foundation). The report also found that on average, workers contributed $6,850 toward premiums out of their paychecks for the cost of family coverage.
Nationally, the median proposed increase for health plan premiums for 2026 is averaging 18%, which is more than double the proposed rate hikes for 2025. While employer healthcare premiums are lower than the median, they are expected to rise another 9% in 2026. The increases are attributed to the higher cost of prescription drugs, the increase in the use of certain services and medications, the impact of new technologies, and general inflationary costs. These huge premium increases come after years of steady cost escalation and put added pressure on businesses already managing tight operating margins.
According to The Commonwealth Fund, nearly all small-business owners believe pharmaceutical companies, health insurance companies, the federal government, and health care providers are at least somewhat responsible for rising health care costs.
For PRINTING United Alliance members, the message is clear: the rising cost of health insurance is a direct threat to competitiveness, workforce retention, and long-term growth. As premiums continue to climb, small businesses face increasingly difficult decisions about hiring, wages, and benefit offerings making health insurance reform an urgent priority for policymakers and the business community alike.
Lobbying Congress
The National Federation of Independent Business (NFIB) Problems and Priorities Survey ranks the rising cost of health insurance as the top problem for small business owners, a trend that has been consistent since 1986.
In October, NFIB sent a letter to Congress supporting the Custom Health Option and Individual Care Expense (CHOICE) Arrangement Act (H.R. 5463 / S. 2875). The bill writes health reimbursement accounts into the tax code, giving small businesses more affordable and flexible health insurance options, according to NFIB. It also provides an exemption for small businesses to allow pre-tax funds to pay for employee health care. The bill has been referred to the House Ways and Means Committee, with a companion measure sent to the Senate Finance Committee. Neither committee has taken up the legislation yet.
ACA Tax Credits
The current fight in Congress over the Affordable Care Act (ACA) enhanced premium tax credits is a major concern for small employers as half of all ACA marketplace enrollees are small business owners, self-employed entrepreneurs, or small business employees. The ACA subsidies are set to expire on December 31, 2025. Without Congress acting to extend them, premiums could more than double, affecting over 22 million people.
A survey of 620 small business owners by Small Business for America’s Future found that 84% of respondents are concerned about their ability to afford healthcare in 2026 if the tax credits expire at year-end. According to the survey, nearly 40% said premium increases will create severe financial strain and threaten their operations. Close to a quarter said they will be forced to drop employee coverage. And 72% of small business owners say Congressional priorities are misaligned with small business needs.
Proposals from some Republicans in Congress would effectively repeal some or all of the ACA premium tax credits and replace them with contributions to Health Savings Accounts (HSAs) or something similar. But many rank-and-file Republicans are still pushing for an extension, worried about voter backlash over the ensuing skyrocketing premiums.
The Alliance works closely with partners such as NFIB and the S-Corporation Association to advance small business priorities, including access to affordable health insurance. Rising premium costs have become one of the most significant threats to hiring, retention, and long-term investment, as small businesses cannot remain competitive when healthcare expenses outpace wages and inflation.
As Congress evaluates the future of health insurance coverage, the Alliance urges bipartisan action to stabilize costs, improve transparency, and preserve affordable options for workers and employers. Ensuring accessible, sustainable health insurance is not only smart policy—it is essential to the economic vitality of Main Street businesses nationwide.
Please visit the Alliance’s Advocacy Center and TAKE ACTION by urging Congress to pass the CHOICE Arrangement Act to help small businesses provide affordable health insurance to workers across the country.
In this article, Stephanie Buka, Government Affairs Manager, PRINTING United Alliance, reports on the rising cost of health insurance and its impact on small businesses. More information can be found at Business Excellence-Legislation or reach out to Steph should you have additional questions specific to how these issues may affect your business: sbuka@printing.org.
To become a member of the Alliance and learn more about how our subject matter experts can assist your company with services and resources such as those mentioned in this article, please contact the Alliance membership team: 888-385-3588 / membership@printing.org.
This article was originally published on printing.org here.
Stephanie Buka is the government affairs manager for PRINTING United Alliance. In this role, she supports Ford Bowers, CEO, the Government Affairs team, and coordinates efforts with contracted lobbying firm, ACG Advocacy. Buka is the editor-in-chief of the Industry Advocate newsletter. She is responsible for advocacy campaigns, policy analysis, strategy development and team leadership, all aimed at promoting the Alliance's legislative agenda. She is also responsible for the administration of the Alliance's political action committee, PrintPAC.
Buka holds a master’s degree in Public Policy and Management from the University of Pittsburgh, Graduate School of Public and International Affairs (GSPIA). She also earned a master's degree in Criminology from Indiana University of Pennsylvania, along with a Certificate in Forensic Science and Law from Duquesne University.
