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WASHINGTON, D.C. — People who rely on employer-sponsored health insurance paid more for their coverage this year, with employees at small businesses and their employers especially squeezed by the surging costs, according to a new survey by healthcare research nonprofit KFF.
The 2026 Employer Health Benefits Survey, released Thursday, found that covered workers were paying hundreds of dollars more toward their premiums this year compared with last year. The costs were particularly pronounced for employees at small businesses made up of 10 to 99 workers who typically shoulder a larger share of their insurance costs than those at bigger companies.
Rising healthcare costs have emerged as an important issue for voters in the midterm elections and are part of broader affordability concerns. An AP-NORC poll conducted in October found that about 7 in 10 registered voters call healthcare “one of the most important issues” in this election.
Almost 157 million Americans under retirement age rely on employer-sponsored healthcare coverage. According to the KFF study, employers report that workers are paying on average $7,471 annually toward the premiums for employer-sponsored family health benefits this year, which is up roughly 9%, or $621, from last year.
“Workers are paying a bigger chunk this year,” said Matthew Rae, associate director of KFF’s Program on the Health Care Marketplace, “which also brings up the issue of affordability.”
President Donald Trump has tried to make healthcare affordability part of his midterms pitch, saying that his most-favored nation prescription drug pricing would reduce costs and promising rebates for some Americans. But other steps taken by Trump’s Republican administration have raised costs for some, and the survey indicates that many are seeing their health insurance expenses climb without clear improvements in benefits.
The impact could be felt more acutely among small businesses, which employ roughly 62.3 million people, or 45.9% of private-sector workers, according to the Small Business Administration.
Covered workers at smaller firms contributed an average of $9,687 in 2026 toward family coverage, compared with $6,840 at firms with 200 or more workers, the survey says. In 2025, they paid roughly $8,900, compared with about $6,200 for larger firms, the report said. The survey found that covered workers at smaller firms contribute an average of 37% of the premium for family coverage, compared with 25% at larger firms.
And 32% of covered workers at small firms are enrolled in plans in which they must pay more than half the family premium, compared with just 6% at larger companies.
The rising costs have meant small businesses must strike a balance between maintaining attractive benefits for their employees and meeting other increasingly costly expenses.
Jenna Caligaris, who manages an upstate New York contractor with roughly 25 workers, said the pressures of providing health insurance to her workers keep her up at night.
Caligaris said that because her firm operates in a field that is extremely competitive for workers, the company looks for any way to keep employees from taking on more insurance cost-sharing. Her firm provides 80% of coverage to its nonunion workers, with employees covering the rest.
From stretching the lifespan of company vehicles and tools to cutting down the size of workers’ year-end bonuses and putting an end to the annual company picnic, “we’re trying to maintain coverage and stay competitive — so we’ll have to eat these price increases,” Caligaris said.
In the past three years, the company has switched insurers to save on costs yet is getting hit this year by a 25% increase in premiums, Caligaris said.
Rae, at KFF, said small firms face higher deductibles than larger companies and more volatility in the market.
KFF’s annual health benefits survey of large and small employers includes roughly 1,900 employers with 10 or more workers.
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