FOR IMMEDIATE RELEASE 

BOSTON, MA (March 14, 2025) – The National Federation of Independent Business (NFIB), Massachusetts’ leading small business advocacy association with thousands of members across the state, released a new health care policy paper entitled, “Addressing the Health Insurance Affordability Crisis for Small Businesses.” Similar to data showing a decline in the number of lives covered by small-group insurance plans in the Massachusetts merged market, these nationwide findings reveal a dire prognosis for the small-group insurance market as employer-provided health coverage is becoming unsustainable for millions of small businesses and their employees.

“Double digit premium increases resulting in continuously rising health insurance costs are a significant burden for the Commonwealth’s small businesses,” said NFIB Massachusetts State Director Christopher Carlozzi. “For decades, health insurance costs have been the number one concern for small business owners. Similar to what Massachusetts has experienced since the implementation of the 2006 health care reforms, this new paper shows the nation’s small-group markets are in crisis, premiums are unsustainable, and small businesses are being forced to make difficult choices. By expanding coverage mandates and limiting basic cost-sharing protections, Massachusetts legislators and regulators continue to make it more expensive for small businesses to provide health insurance to their employees. Main Street businesses lose, and their workers lose.”

Key findings from the report:

• The small-group market is in freefall, with enrollment plummeting from 15 million individuals in 2014 to just 8.5 million in 2023, a 44% drop.
• Average premiums for small businesses have skyrocketed: Average single plan premiums have gone up 120% in the last two decades, while average family plan premiums have increased by 129% for firms with 50 or fewer employees.
• Only 30% of small businesses still offer health insurance, down from nearly 50% in 2000.
• Ninety-eight percent of small businesses say they are concerned about whether they will be able to afford to continue offering health insurance in the next five years.
• Small businesses pay twice as much for health insurance as large businesses, firms with less than $600,000 in revenue spend nearly 12% of payroll on health benefits, compared to 7% for firms with over $2.4 million in revenue.

Legislative recommendations include:

• Protect Employer-Sponsored Insurance
• Support Small Businesses with Targeted Health Insurance Tax Credits
• Expand Individual Coverage Health Reimbursement Arrangements (ICHRAs)
• Improve Employer Pooling Arrangements
• Expand Access to Health Savings Accounts (HSAs)
• Protect Small Businesses’ Access to Stop-Loss Insurance
• A Moratorium on One-Size-Fits-All Mandates (Massachusetts already has more than 50 state mandated benefits over what the ACA requires.)
• Promote Price Transparency and Price Certainty
• Discourage Hospital Consolidation
• Reduce Prescription Drug Prices Through Innovation

View “Addressing the Health Insurance Affordability Crisis for Small Businesses” 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.