Businesses large and small have been struggling to make their health care costs work for them in the last several years, in part – but not entirely – due to the rules put in place by the Patient Protection and Affordable Care Act. Health insurance prices were rising sharply for years before the law was implemented, and this situation has slowly forced many companies, but particularly independent enterprises with fewer employees, to make difficult decisions about how to cover those costs.

Today, health insurance costs are so significant that about 1 in 6 small businesses say that they can only offer reimbursement for health insurance purchased individually by employees through state and federal coverage marketplaces, according to a new survey from the National Federation of Independent Business. In addition, about 1 in 5 more say they're considering doing the same thing, simply because those costs plus the fines they accrue from the federal government might end up being cheaper than simply paying for coverage.

What's the issue?
Indeed, 63 percent of companies that offer health insurance to their employees in the traditional fashion saw the premiums they were charged by insurers rise at least somewhat between the midpoint of 2014 and the same time this year, the report said. Further, 27 percent saw no change in their coverage costs, while just 8 percent saw them drop a little. To that end, more than half of all small businesses that don't offer their employees health insurance these days say that they're doing so because of the cost of coverage.

The cost of coverage is often too significant for small businesses to bear.The cost of coverage is often too significant for small businesses to bear.

What's good for the goose
Meanwhile, more than 2 in 5 small business owners report that the coverage they have is coming through the health insurance exchanges, an increase of 11 percent in just two years, the report said. Another 1 in 3 or so say they're covered through the company they run, and more than 1 in 6 report getting their insurance through a spouse's health insurance. Those numbers haven't shifted much during the same time period.

Interestingly, though, only 3 percent of respondents said they were interested in trying to buy coverage through the federal government's SHOP exchanges, which are designed specifically for small businesses, the report said. In fact, about 2 in every 3 owners polled said they have no interest in getting coverage through either the small business or individual exchanges, despite the mounting concerns about the cost of coverage through private sources.

One of the best ways for small business owners to avoid these potentially troubling financial issues, which can lead to unhappy employees, is by sitting down with their advisors and coming up with a financial plan that will allow them to continue absorbing many of the costs associated with health coverage. That, in turn, could end up putting everyone involved in a better position moving forward, and perhaps more importantly improve the perception of the benefits workers feel they're getting from the company.