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A new report on how smaller employers have been dealing with rising health care costs revealed that more than 40% are considering switching insurers and more than 25% are looking at increasing deductibles and other out-of-pocket costs for employees.

The WSJ/Vistage Small Business Index found that confidence in the economy among small businesses is declining, despite relatively good economic numbers. The report noted that although inflation is now growing at a slower rate and the Federal Reserve held off an interest rate hike in September, CEOs of small businesses are still not optimistic. “Analysis of this monthly survey of small business leaders showed that economic sentiment is on the decline,” the report said. “Most notably, the proportion of small businesses that expect the economy to worsen in the year ahead has risen to 49%, a 9-point gain in one month.”

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