The cost and ability to provide health-care insurance is a major concern for small businesses, many of which are already struggling in a lagging economy and challenging hiring environment. With the fate of Obamacare hanging in the balance, the debate over health-care reform will likely hit a fever pitch as the 2012 presidential election draws near.

The Small Business & Entrepreneurship Council recently released its "Health Care Policy Cost Index 2012," which ranks the states and the District of Columbia on public policy measures that impact the costs of health-care and health-insurance coverage.

Here's what some small business owners have to say about the cost of health-care insurance in this country and their states.

KikScore Washington, D.C.

Rajeev Malik, co founder and CEO of KickScore, a company that grades small businesses and gives them merchant report cards, said action needs to be taken to make it more affordable for small businesses to insure their owners and employees.

"The cost is becoming prohibitive to expanding and growing businesses that should grow," Malik said.

For those that are starting their own businesses, assuming they left a previous job, Malik said the best move is often to hold onto COBRA insurance for as long as possible.

"If you did not have insurance at your last job and you are starting a business, it is really imperative that you have enough money set aside for yourself to cover your health insurance costs let alone the costs of covering your employees through the income of the business," he said.

Aya Designs Atlanta, Ga.

Aya Turner, owner of the handmade jewelry company, said she is lucky to have had insurance for years, first through marriage and now through a domestic partnership with her boyfriend of more than 10 years. However, she said she is dissatisfied with insurance policies in her state, Georgia, as well as the overall country.

"Our biggest problem is the greedy insurance companies who have made health care so unaffordable for most while lining their pockets," Turner said. "We are in dire need of an overhaul.  I would love to see both parties in government work towards a solution that actually has their constituents' best interests at heart, but then we can't even get our elected officials to get along on any issue, so the stalemate continues.

Small business is so vital to the U.S. economy, that insurance affordability should be a priority for Washington, she said.

Mike's Masks Williamsburg, Va. 

Owner Mike Vahey said his company has one other employee and does not offer health insurance. Both are covered by their spouses' plans, however once the company grows, this plan won't sustain, and cost will be a major factor for him to consider.

Vahey said he believes government has grown too large, and the Patient Protection and Affordable Care Act oversteps its boundaries.

"It overrides states’ abilities to enact their own policies. As a citizen of Virginia, I worry that the cost [of] health care … will incur in the future will be enormous," he said. "I know that Virginia has challenged the bill in court. I would like to see the bill deemed unconstitutional and repealed. What we need to reduce health care costs [is] better competition among providers, including cross-state competition, and tort reform, to reduce frivolous and ridiculously high awards."

Follow Kate Rogers on Twitter at @KateRogersNews