It used to go without saying that a full-time job came with employer-sponsored health insurance.

But an increasing number of small businesses no longer offer health insurance to their employees, according to a survey of 810 small businesses conducted from Sept. 16 to Oct. 6 by the National Small Business Association (NSBA).

All told, 65 percent of companies polled offered health insurance this year--down from 70 percent the year before. Most of the companies in the survey have been in business for some time: 89 percent have existed for more than five years. The survey sample included a wide diversity of industries and U.S. regions. For the sake of the survey, a small business was defined as a company with 500 or fewer employees. Annual revenues of the companies ranged widely, but a majority (62 percent) were between $500,000 and $25 million. 

Not surprisingly, respondents said that cost was the top factor in determining whether they offered health insurance. The NSBA points to rising premiums as the main reason fewer companies offered health insurance this year. Of the surveyed group, 90 percent reported increases in their health plan at their most recent renewal. What's more, 95 percent reported increased health insurance costs over the past five years. And 84 percent expected an increase in the coming year. 

The survey also showed that while businesses have a greater understanding of the Affordable Care Act, there is still a long way to go. Specifically, 49 percent said they grasped how the ACA would impact their business. That was an increase from last year's total of 42 percent. But it was still a minority. Of the remaining 51 percent, 42 percent said they had a limited understanding of the ACA, while 9 percent said they had no understanding of it. 

One of the most revealing indicators was the response to a specific question the NSBA asked: "Are you aware that, under the Affordable Care Act, businesses in 2016 may have to begin reporting to the IRS on their 2015 insurance offerings to ensure compliance with the individual and employer mandate?"

In response, 36 percent said they were unaware of the requirement. What was also evident from the survey was the time constraint of studying the ACA: Respondents indicated that the average time it took to stay abreast of the ACA was 13 hours per month. NSBA Chair Timothy Reynolds, president of Tribute, Inc. in Hudson, Ohio, compared the burden to four work weeks every year. "We need to focus on growing our businesses but the increased costs and compliance burden the ACA puts on us only makes that much more difficult," he said in a statement