According to a story in Chicago Business, the smallest businesses have always been the least likely to pay for employee health insurance, and ever-increasing premium rates and the recession are prompting even more of them to drop out of the system.

In 2001, 58% of firms with three to nine employees provided health coverage, according to the Menlo Park, Calif.-based Kaiser Family Foundation; in 2009, only 46% of the smallest firms did, compared with 72% of companies with 10 to 24 workers, 87% of companies with 25 to 49 workers and more than 95% of firms with 50 or more workers.

So what’s a micro-business owner to do?

“I get acupuncture, and I take vitamins,” says Julie Northcutt, CEO of Caregiverlist Inc., a three-year-old Web site that helps families and senior care agencies find home-based aides. “The Pacific College of Oriental Medicine is three blocks from my house, and I try to go once a month, which costs $35.” Ms. Northcutt has tried to avoid paying for benefits at her Chicago-based startup by hiring mostly part-time, independent contractors and encouraging full-time employees to jump on their spouse’s health plans if they can.

The few remaining full-timers, including her, have individual plans, and the company reimburses their premium costs. Ms. Northcutt shells out $350 a month for her plan, which pays for 100% of her health care once she’s hit $5,000 a year in medical expenses. “When you know you’re paying out of pocket, you try to stay healthy,” she says.

Photo by drdavidtucker.