The rising cost of health care continues to be the top problem facing small business owners, according to a new study.

The report by the National Federation of Independent Business (NFIB) revealed that more than 50 percent of small business employers view the cost of insurance as their most critical problem. 

According to the research, health insurance costs for small firms have risen 103 percent in the last decade, an increase outpacing wages and inflation.

"Fears over increasing health insurance costs continue to dominate the list of concerns for small businesses," said Holly Wade, senior policy analyst for the NFIB and the survey author, noting that it has been the top problem facing small businesses each of the eight times the study has been conducted over the past 25 years.

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Among the other top 10 problems facing small business owners are:

  • Uncertainty over economic conditions
  • Cost of natural gas, propane, gasoline, diesel, fuel oil
  • Uncertainty over government actions
  • Unreasonable government regulations
  • Federal taxes on business income
  • Tax complexity
  • Frequent changes in federal tax laws and rules
  • Property taxes (real, inventory or personal property)
  • State taxes on business income

New to the rankings were uncertainties over economic conditions and government actions, which the report says have been a major hurdle to small business recovery and growth.

"This year's survey was conducted on the heels of the worst U.S. recession since the 1930s," Wade said. "The high level of uncertainty cited by small employers helps to explain the sector's inability to recover and expand."

The least severe problems for small business owners include exporting products and services, undocumented workers and access to high-speed Internet. The largest decline in the ranking was in regards to interest rates, which dropped 30 positions to No. 62. Also declining in importance and severity were finding and keeping skilled employees and employee turnover, both of which fell 21 positions.

The study was based on surveys of more than 3,800 small business owners.

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