A growing proportion of small businesses in America are no longer offering health care benefits to their staff because the rising cost of insurance is pricing them out of the market.
A study by the National Small Business Association has found the cost of health insurance, fuelled by an ageing, increasingly unhealthy population, is now a major concern for nearly four out 10 small business owners.
A similar percentage of the 500 firms polled were increasingly uneasy about the future direction of the economy and just under a third were worried about a lack of available capital.
While 58 per cent of small-business owners offered health insurance to their employees a decade ago, that number declined to 51 per cent in 2000 and was now down to 41 per cent, said the association.
This drop was especially worrying because when they were asked which benefit they'd most like to offer their employees, three-quarters opted for health insurance.
When it came to obtaining adequate financing, ten years ago nearly a quarter of business owners reported being unable to access what they needed.
But by 2007 this had risen to a third, with the smallest businesses (those with four or fewer employees) most likely to turn to credit cards to fund their operations.
More than two out of five felt the U.S economy was in worse shape than five years ago, with women and minorities significantly more likely to feel this way.
Yet the vast majority (81 per cent) were optimistic about their own prospects. Some two thirds expected gross revenues and net profits to increase in the next 12 months.
"Small-business owners' concern about the increasing cost of health insurance and a lack of access to capital is a wake-up call for policy makers in Washington," said association president Todd McCracken.
"Business owners are now willing to embrace health care reforms to a degree that will surprise many people," he added.