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Small businesses say years of crushing health care costs have them backing major changes this time around. The NFIB helped derail President Bill Clinton's effort to overhaul the health insurance system during the 1990s. Now, small companies with an average of 10 workers are bearing the greatest burden of insurance premium increases, which have grown twice as fast as inflation for several years. They've started lobbying the presidential candidates early and are pushing for changes to taxes and state laws.

It is much cheaper per employee for large companies to provide health insurance, with more employees to balance risk and spread administrative costs.

And workers pay 18 percent more for premiums than their counterparts at larger firms, according to a study by the Commonwealth Fund, a nonprofit research group.

"The NFIB is starting to listen to its members," said Peter Harbage, a Democratic health strategist who has worked for former presidential candidate John Edwards. "The whole health-care system seems designed to work against small business."

These companies represent 80 percent of total U.S. employment. The influence lies in these hard numbers, but also their ubiquitousness in grass-roots politics.