Nearly 157 million Americans under retirement age rely on employer-sponsored health insurance, but rising premiums are putting greater pressure on workers and businesses, according to a new survey from healthcare research nonprofit KFF.

Workers with family coverage paid an average of $7,471 toward annual premiums in 2026, an increase of $621, or roughly 9%, from the previous year. The burden was particularly heavy for employees at smaller companies, which often require workers to cover a larger share of insurance costs.

Employees at businesses with 10 to 99 workers contributed an average of $9,687 toward family coverage this year, compared with $6,840 at companies with 200 or more employees. Workers at smaller firms typically paid 37% of family premiums, while those at larger companies paid 25%.

The survey found that 32% of covered workers at small businesses were enrolled in plans requiring them to pay more than half of the family premium, compared with just 6% at larger firms.

The rising costs are becoming a political issue ahead of the November midterm elections. An October AP-NORC poll found that roughly seven in 10 registered voters considered healthcare one of the most important issues in the election.

Small businesses face particular challenges because they must balance employee benefits against other rising expenses. Jenna Caligaris, who manages a New York contractor with approximately 25 employees, said her company has switched insurers in recent years to control costs but still faces a 25% premium increase this year.

Her company covers 80% of insurance costs for nonunion employees. To absorb rising expenses, the business has extended the use of company vehicles and tools, reduced year-end bonuses and eliminated its annual company picnic.

“We’re trying to maintain coverage and stay competitive, so we’ll have to eat these price increases,” Caligaris said.

Matthew Rae, an associate director at KFF, said smaller businesses also tend to face higher deductibles and greater volatility in the health insurance market.

President Donald Trump has promoted healthcare affordability as part of his midterm agenda, pointing to prescription drug pricing initiatives and promised rebates for some Americans. However, the survey suggests many workers are facing higher insurance costs without clear improvements in their benefits.

KFF's annual survey examines employer health benefits at companies with 10 or more workers and included approximately 1,900 employers.