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When UnitedHealthcare hiked insurance premiums by more than a third for PAVE Technology Co. a few years ago, owner Walt Wood shopped around. He kept his rising premiums at a reasonable trajectory by joining a purchasing alliance, which approached insurers with the leverage of "several thousand instead of our 40."

Then last year's renewal rate was high enough that Wood looked around some more. PAVE, which designs and manufactures specialty electronics components in Dayton, went back to United.

"I didn't look forward to what I call the Spanish Inquisition of shopping for insurance," he said, "but it's better than some of the horrendous rate increases I've seen."

The national stampede of runaway health care inflation is leaving more hoofprints on small businesses than on the rest of the fed-up country. They pay 18 percent more than big companies for the same insurance, the Commonwealth Fund reported in 2006. Most don't have the benefits specialists and purchasing power to wrangle bargains, or enough premium-paying workers to cover a major illness.

"Access to affordable health insurance is the No. 1, No. 2 and No. 3 issue for small businesses," said president Todd Stottlemyer of the National Federation of Independent Business.

"Costs just keep escalating and escalating," said owner Janice Grieshop of Celina Tent, "like it's out of control."

Only 45 percent of companies with 10 or fewer workers offered health insurance last year, down from 58 percent in 2001 in Kaiser Family Foundation surveys. Even where it's still available, employers tend to increase paycheck withholdings for premiums, decrease the covered services or leave employees liable for higher out-of-pocket expenses.

As one result, U.S. small-business workers and dependents make up 60 percent of the 47 million without insurance. Statewide, the percentage of working-age adults 18-64 has leapt from 12 percent in 2006 to 19 percent in the University of Cincinnati's latest Ohio poll. Three of every 10 went without insurance sometime in the past year.

Grieshop decided her tent-making company would buck the trend. "To keep better employees, we started paying full insurance premiums," just charging employees the extra cost for family coverage.

Then Medical Mutual of Ohio's premium this year went up more than 70 percent.

"We changed companies," Grieshop said. From about five bids, Aetna offered a negligible increase.

"The good thing about all these companies being publicly traded is that we can look at their financial reports," said Scott McGohan, Grieshop's benefits consultant with McGohan Brabender in Kettering. "Every quarter, some of them need earnings."

United is tying to make up market share it lost to Anthem Blue Cross and Blue Shield, he said, so it gave one small business a zero-increase bid after Anthem's 13 percent renewal increase. The company wound up staying at Anthem with 3 percent, "all because of competitive bidding."

"Small businesses are trying to survive in the marketplace," Barron said. "They know they need to provide benefits or they're not going to have the work force. So they're doing everything they can."

Health insurance tips for small businesses

Ohio Department of Insurance director Mary Jo Hudson offers this broad advice on health insurance for small businesses:

Work only with insurers and agents licensed by ODI.

Understand your health plan — not just the premium amount — including co-pays and specific changes from the previous year. "Make sure the benefits match what your employees need or want," Hudson said.

Health discount plans commonly advertised on TV "are not insurance," she said, "but just sort of buyers clubs."

Basic tutorials on all types of insurance are at www.insureUonline.org, also reachable through the ODI's www.ohioinsurance.gov. And the ODI's Consumer Services hot line is (800) 686-1526.