Change, it's said, is the one constant in everyone's life. That's also true for small business owners, with one expensive exception.

The cost of health insurance has been the number-one small business problem for more than 20 years. That status was just confirmed once again in the 2008 edition of Small Business Problems and Priorities, a study conducted every four years by the National Federation of Independent Business.

This study is unique in that most surveys are more narrowly focused and are limited to addressing relatively few problems. Small Business Problems and Priorities asked more than 3,500 small business owners from around the country their views on 75 different issues. The list includes problems with obvious public policy implications, as well as those related to managing the business. The combination provides a broad context and shows the relative priorities that small business owners assign to their everyday problems. In that respect, it's a critically important guide for policymakers.

The principal reason that health insurance costs continue to reign as the top problem is because for small businesses, those costs have risen 129 percent since 2000. These huge increases have forced some small business owners to drop employee health plans, while preventing others from offering one in the first place. Only about 59 percent of small firms (3–199 employees) now offer a health plan, down from 68 percent in 2000. So it's little wonder that 56 percent of small business owners consider the cost of health insurance to be a critical problem.

Energy costs (except electricity, addressed as a separate issue) are the second most-pressing problem for small business owners in 2008, two positions higher than in 2004. Reflecting the rapid increase we've all experienced in energy prices, 43 percent consider the problem critical, compared to one-quarter of owners four years ago. Electricity rates rank 9th in 2008, up one spot from 2004, and 16 percent of business owners say that rates are a critical problem.

Four of the top 10 problems concern taxes, federal, state and local. Federal taxes on business income ranks 3rd, up from 5th in 2004. The state equivalent ranks 7th, compared to 8th in 2004. Business owners ranked taxes on property (real, inventory or personal property) 4th in 2008, up from 6th in 2004.

The fourth tax-related problem is a new issue included in the 2008 survey—the complexity of the tax code. It ranks 5th among the survey's issues and is a critical problem for 23 percent of business owners.

Tax complexity has reached the point where 88 percent of small business owners opt to pay a tax preparer or accountant to do their federal tax returns because they just can't keep up with ever-changing laws and regulations. The complexity of the tax code also makes sound long-range planning a nightmare for entrepreneurs.

You may have noticed that the surveys are conducted in presidential election years. That's no coincidence. Small businesses are the principal creators of new jobs in this country and represent a powerful voting bloc, and therefore are a key audience for any politician. If elected officials and candidates for public office want small businesses to continue creating jobs and growing the economy, they should look at the Small Business Problems and Priorities survey results and get to work addressing these issues.

Todd Stottlemyer is president and CEO of the National Federation of Independent Business in Washington, D.C.