Every four years, the National Federation of Independent Business releases a study ranking small business owners’ problems and priorities. They say in New York that while the top ranker is no surprise, there are items that are of higher concern in New York than in other states.

“We cover all of the buckets that small business owners deal with on a day-to-day basis,” said New York State Director for the National Federation of Independent Business Ashley Ranslow.

Ranslow explained those buckets represent 75 situations or concerns that small business owners are asked to rank. A national sample of 40,000 NFIB members was drawn with a separate sample of 1,500 drawn for New York to create state-specific rankings.

Coming in at number one in New York state is the cost of providing health insurance. It’s been number one since 1986, and she argued that part of that boils down to the nature of health insurance.

“The smaller you are the more difficult it is to provide affordable health insurance because you’re in a small group market,” she said. “Health insurance goes up every year for everybody but it goes up more for small business owners because they’re purchasing such a small amount compared to their larger business counterparts.”

Eric Linzer, president and CEO of the New York Health Plan Association, blames the high ranking on two things, the increasing cost of care and legislation mandating benefits coming out of Albany.

“These services in isolation may have minimal cost, but when you add them up they add significant cost for small businesses, I think policymakers need to look at the necessity of some of these proposals,” he said.

Linzer and others fear it could get worse for small business owners if the state passes the New York Health Act and transitions to a single-payer system.

“It will significantly increase taxes on employers and consumers, and has a rough estimate of more than $250 billion,” he said.

Advocates for the New York Health Act disagree that it will exacerbate the problem. State Sen. Gustavo Rivera says there is evidence to the contrary.

"The coalition supporting the NY Health Act is consistently reaching out to business owners who struggle with the high cost of their own health insurance. Establishing a single-payer healthcare system would eliminate out-of-pocket costs and the administrative hassle for business owners and their employers,” he sai.d According to a study conducted by the RAND Corporation, by eliminating premiums, co-pays, deductibles, and other out-of-network costs, more than 95% of New Yorkers, including small business owners, would save money under the New York Health Act.

Ranslow, though, insisted that concerns about health insurance are par for the course nationwide and therefore unsurprising. So where does New York differ from other states?

“Taxes on business outcome ranked at number three when compared to nationally that ranked as number nine,” she said.

Also ranking higher in New York than other states were unemployment insurance, workers' compensation, and the cost of gas and electricity

Ranslow said lawmakers should take note.

“Workers' compensation is significantly higher than in the rest of the nation, unemployment insurance is substantially higher. These are issues that state lawmakers can tackle and create,” she said.

Also in the top 10 in New York are the cost of supplies and inventory, uncertainty over economic conditions and government actions, and locating qualified employees.