Tom Slade attended a recent small gathering of printing company officials in Billings, Mont., when up came the topic of employee health-care insurance.

It wasn’t the first time, but this time “it was one of the main agenda items,” said Slade, who with his wife, Lisa, owns Alphagraphics of Evansville, Ind.

Everyone at the conference agreed that rising health insurance costs were getting out of control.

“It’s not unusual for us to look at 20 to 30 percent increases on a yearly basis,” said Slade. “This is one of the hot topics for businesses with 10 to 20 employees.”

It’s a hot topic for bigger companies, too.

“Like everyone else, costs just keep going up and up,” said Brad Hershberger, general manager of Kight Home Center, an Evansville company that employs 170.

“I think part of the problem is the perception in society that business can bear the brunt of anything,” Hershberger said.

Two-thirds of Americans — more than 163 million people — get their health coverage through their employers, according to the U.S. Chamber of Commerce. And in recent years, paying for employee benefits has increasingly become a burden.

The chamber estimates there are 41 million uninsured people across the nation. About half of the uninsured work for small businesses with fewer than 100 employees, the study found.

Most companies that don’t offer insurance to their employees cite the cost. But they also complain of administrative hassles, said Kate Sullivan, health-care policy director for the U.S. Chamber.

The problem for small companies is that it’s difficult for them to self-insure, Sullivan said. Companies with more than 150 employees normally self-insure. Those with fewer than 100 employees rarely do.

Self-insurance usually lowers costs for employers and gives them more flexibility in their policies, Sullivan said. But it’s not economical for small companies because they have too small a pool of employees to work with, and the pool’s insurance history can fluctuate severely, she said. Thus, small companies usually must buy policies from an insurance company. The insurers are often restricted in their flexibility, Sullivan said.

But large companies that can self-insure are affected, too.

“It seems like it’s becoming a larger and larger portion of our compensation package,” said Jeff Mulzer, vice president of administration for Mulzer Crushed Stone, based in Tell City, Ind. The firm has about 400 employees.

Sullivan said lawmakers should take a multifaceted approach. It will take public programs, tax incentives and other action.

“The reality is health care is a personal matter and people want a personal approach. It’s going to take many solutions.”