When Laura Lee Jones learned in May that the cost of health insurance for her 16-employee company was going up a whopping 19.6 percent, she was hardly surprised.

The company expects to pay nearly $22,000 in premiums under the coverage that kicked in June 1, up from about $18,400 last year. The premium rate alone jumped 13 percent, and the rest of the increase was the result of three more employees being added to the plan.

But as many companies in the coming weeks and months decide whether to renew their health insurance, relief of any kind can't come soon enough.

Some, such as LionShare, will manage to stick with conventional health plans. Others will explore newer options such as health savings accounts, association plans and outsourcing.

Rising health insurance costs bedevil businesses of all sizes. The Kaiser Family Foundation reported last year that the average premium for employer-sponsored health coverage rose 9.2 percent between spring 2004 and spring 2005. Even though that fell below the previous year's increase of 11.2 percent, it still far outpaced the overall inflation rate of 3.5 percent.

But small businesses can get hit with much bigger increases. For one thing, small businesses bring less bargaining clout to the health insurance negotiating table.

SurePayroll, a Chicago-based payroll service provider for small businesses, reported in July that 11 percent of the small businesses currently offering health coverage might pull the plug next year.

"If you think that we've got health insurance issues now, imagine if 350,000 small businesses stopped offering health insurance in 2007," SurePayroll president Michael Alter said.

As it stands now, 59 percent of small businesses (in this example, companies of three to 199 workers) offered health insurance in 2005, down from 68 percent in 2000, according to the Kaiser foundation.

The effect of these trends extends far beyond the small-business workplace. If employees lose health coverage at work and can't obtain it on their own, they might show up as charity cases in hospital emergency rooms. "Eventually, they have to be absorbed by the system someplace, and society picks up the cost for a lot of these people," said Dale Finke, director of the Missouri Department of Insurance, Financial Institutions & Professional Registration.

On its Web site, the U.S. Chamber of Commerce says nearly 60 percent of the nation's uninsured -- more than 45 million -- work for small firms.

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