Poll: Small Businesses Struggling with Health Insurance Premiums, Tariffs as Pessimism Remains High

Washington, D.C.— Small business owners are feeling more pessimistic than they were in the previous quarter amid concerns about health insurance premium costs and tariffs as well as the impact of immigration enforcement, according to a new survey.

Voice of Main Street, a quarterly opinion poll of entrepreneurs in Small Business Majority’s network, which consists primarily of women- and minority-owned businesses with fewer than 10 employees, finds 41% of small business owners are pessimistic about their business outlook for the next six months. 

One of the major concerns among small businesses is the growing cost of health insurance. Nearly two-thirds (63%) say increasing healthcare premiums are a financial burden on their business, with 47% saying they're a major burden. As a result of healthcare premium increases, entrepreneurs anticipate that they will struggle to invest in their business (47%), attract and hire new employees (31%) and retain current employees (23%). Notably, 13% of small business owners say that they would have to close their business to get health insurance through another employer if health insurance premiums continue to rise. To address these concerns, 68% of small business owners support extending the Affordable Care Act’s enhanced premiums tax credits, which lower premiums for 93% of Affordable Care Act (ACA) Marketplace participants.

“With the enhanced premium tax credits set to expire, I honestly won’t be able to afford my health plan if that happens,” said Karin McKie, owner of Tree Falls Productions in Chicago. “Right now, I pay about $550 a month, and that’s with tax credits covering around 50%. Without those credits, it would cost close to $1,000 a month—which I simply couldn’t afford. Before the ACA, I only had insurance now and then, when I could scrape together the money. As a freelancer, that was just the reality. The federal subsidy is essential because small businesses—collectively the largest employer in the country—are the backbone of our economy.”  

Tariffs also continue to be a major pain point for small businesses, with half of small business owners saying they have increased the price of certain materials or products, 29% have delayed importing materials or goods and 22% have delayed business growth expansion plans in response. Small businesses also report that they’ve sought suppliers in other countries where there is less tariff impact (15%), changed their business model and/or their product offerings (11%), delayed hiring new employees (11%), laid off workers and/or reduced their hours (4%) and some have even closed (1%). Only 33% of entrepreneurs report tariffs have not impacted their businesses.

Additionally, small businesses report negative impacts from aggressive immigration enforcement. Entrepreneurs say their customers (29%) and suppliers (22%) have been affected, their business has lost revenue (16%) and that their business has lost employees who either have been detained or are afraid to come to work (9%). A plurality (47%) of small business owners say that increased immigration enforcement has had a negative impact on their business. Only 9% say that it’s had a positive impact on their business.

When asked about other types of obstacles they’re facing, small business owners say reduced consumer spending (82%), increased costs of supplies/inventory (80%), difficulty making payroll and/or paying expenses (74%) and difficulty accessing financing (64%) are the top challenges for their business. 

In the face of these challenges, nearly half (45%) of small businesses report declining revenue, two-thirds report that business expenses have increased and 24% say headcount has decreased over the past three months – a nine percentage-point increase from the previous quarter.

“This is unquestionably a challenging time for small businesses as they face headwinds from healthcare costs, tariffs, immigration enforcement actions and broad uncertainty throughout the economy,” said Small Business Majority Founder & CEO John Arensmeyer. “Fortunately, many of these issues can be addressed by lawmakers in ways that would provide immediate relief for Main Street. Lawmakers must prioritize the health of small businesses and take decisive action now on behalf of America’s job creators.” 

The fourth Voice of Main Street survey is a poll of 188 small business owners in Small Business Majority’s national network. Forty percent of respondents in the sample report business revenues of less than $100,000 while 59% identify as female and 39% identify as a race other than white. The survey was conducted Sept. 11 to Oct. 27, 2025. The margin of error is +/- 7% at a 95% confidence level.