Fellers, who employs 35 workers at his Springfield restaurant supply company, Fellers Fixtures, said he used to pay 100 percent of his employees' health benefits. But he can't afford that expense today.

His dilemma is a problem for the entire country.

Health benefits are key to attracting talented workers who help fuel the economy. But most of the nation's 5.6 million small businesses say they can't afford to offer those benefits.

As a result, uninsured workers at small companies account for 57 percent of all uninsured workers, according to The Commonwealth Fund, a health research group. Those workers contribute to overcrowded emergency rooms and increased health care costs for everyone.

One possible solution: Let small businesses band together across state lines to form "association health plans" that could negotiate less expensive health care coverage.

"This is an idea that would empower small-business people, get administrative costs down and wouldn't cost a penny," said Republican Sen. Jim Talent of Missouri, who has sponsored a bill to allow such plans.

Republican Sen. Christopher Bond and Wendell Bailey, the regional advocate for the U.S. Small Business Administration's Office of Advocacy, support the bill.

"I think it has to be passed," said Bailey, the former Missouri congressman and small-business man who owned several car dealerships in Willow Springs.

Small businesses, which employ about half the nation's 115 million private-sector workers, list the rising cost of health care as their No. 1 concern. They note that:

• Employees at small businesses have higher deductibles and get fewer benefits than employees at large companies, studies show.

• More than half of businesses that employ fewer than 50 workers don't offer their employees health insurance. Among big companies, only 3 percent don't offer insurance, according to the Kaiser Family Foundation, a health research group.

In Missouri, nearly 59 percent of businesses that employ fewer than 50 workers don't insure them. But only 2 percent of firms in the state with more than 50 employees don't insure their workers.

• Health care premiums for businesses with fewer than 200 workers climbed 15.5 percent last year. The increase was 13.2 percent for larger companies, according to Kaiser. Last year, companies of all sizes paid an average of $3,383 to insure a single worker, the foundation reported. The cost was $9,068 to insure a worker's entire family.

Springfield businessman Fellers, singled out by President Bush at a 2002 political rally at Southwest Missouri State University as an example of a hardworking businessman, said his employees help pay for a company health plan that provides fewer benefits.

Even so, he spends $100,000 annually on health benefits, his third-largest expense. He said his premiums are rising 25 percent to 30 percent annually.

"It would help if I could get even a 10-to-15 percent reduction," Fellers said.

Talent and other lawmakers say that's the promise of association health plans. Under the proposal, one of several being considered by Congress, the plans would be regulated by federal labor officials rather than state officials, who regulate insurance plans for larger companies.

The bill's supporters, including the National Federation of Independent Business, say it would make health insurance for small businesses more affordable and accessible.

But the proposal faces stiff opposition from the nation's governors, including Missouri Gov. Bob Holden, state insurance regulators, consumer groups, some small-business groups and some lawmakers. They say association health plans shouldn't be exempt from state-mandated benefits and regulation.

"It's not going to work if we deregulate small business," Alabama Insurance Commissioner Walter Bell said. "There is no silver bullet. We just have to make health insurance more affordable for everybody."

Rochelle Balch, who owns a computer-consulting firm in Glendale, Ariz., said she pays more for insurance than large companies pay but gets less coverage for her 10 employees.

"We get screwed because we are small," said Balch, who waits 60 days to insure new workers in order to save money.

Minority business owner Charles Johnson, who owns a security firm in the Bronx, N.Y., said rising health-care costs are an equal opportunity problem for all small businesses.

"It doesn't matter what race or ethnicity you are — you just have to have the money," Johnson said. He said he stopped insuring his workers about 15 years ago because it became too costly.

Instead, Johnson gives his 175 employees the option of buying their own insurance by paying them cash, between $2 and $3 above their hourly wage.

"It's cheaper than providing insurance and it empowers my employees," Johnson said. "And it lets me focus on my business — security — and not health care."