Exploding health-care costs have been small businesses' biggest problem for years. And it's not getting any better. More than half of the 365 small businesses that the National Association of Professional Employer Organizations (NAPEO) surveyed in late November said that their premiums rose by as much as 10 percent in 2007 year. One-fifth said they saw increases of 11 percent or more.

To relieve the pain, more and more companies are passing at least some of the increases on to workers. Some smaller companies are scrapping their insurance programs entirely; new companies are often reluctant to offer health benefits at all. As a result, every year, more Americans face the terrible risk of going without health insurance. There are now 47 million uninsured people in this country, many of them children.

Business groups across the spectrum are calling for change. NAPEO believes one way to force reform is to document the impact of the health-care crisis on its clients, America's small businesses. In late 2006, NAPEO began taking the pulse of its members' small-business clients every quarter. The first survey, fittingly, concerned health care. The follow-up November 2007 survey on health care demonstrates continued discontent with the status quo. A sampling of the 2007 survey's findings follows: [For the complete survey, go to www. napeo.org.]