Franceschi immigrated to New Haven in 1971 from her native Argentina. Like many Argentinians, she is of Italian descent. She has run the store in Fair Haven since 1987. Her husband worked at Lender's Bakery for many years, where he had good health insurance that covered his family.

When the Lenders sold their business, her husband left his job and the Franceschis cobbled together health coverage for a few years, then had no insurance for awhile. When they tried to get reasonably priced insurance, she said, "We couldn't buy it directly from a big insurance company -- we had to go through a broker because we're self-employed." And they don't have an expert to negotiate for them, as large firms do.

She said she helped survey the 54 members of GAVA -- the Grand Avenue Village Association, comprised of fellow Fair Haven merchants -- about health care. The group found that 80 percent can't afford insurance. "We are not asking too much," she said of the GAVA members, "just the same rate big companies get."

The majority of Americans still get their health coverage through their employer, but that number has dropped from 68 percent of non-elderly Americans in 2000 to 62 percent in 2006, according to a May 2008 report from the Alliance for Health Reform. And while the percentage of large employers offering coverage has stayed steady at 98 to 99 percent since 1999, the percentage has dropped among small employers, from 68 percent in 2000 to 59 percent in 2007.

And employers with the fewest workers (10 and under) are the least likely to offer insurance.

That leaves small enterpreneurs like Franceschi and the people who work with them in an increasingly harder place.

80% Can't Afford It

Harland Henry, director of the Small and Minority Business Services Unit in the Secretary of the State's Office, said his department has run nine business roundtables around Connecticut. "At every one of them the main issue was health care costs."

He added that nationally, "Over 80 percent of small business owners say health care is not affordable to them and most want some sort of government intervention at the municipal, state or federal level."

Henry noted that in this year's session, the General Assembly passed a bill that would allow small businesses to participate in the state employees' health insurance plan, but it was vetoed by Gov.M. Jodi Rell under pressure from industry lobbyists. He noted that the governor's modest, alternative, her Charter Oak health plan doesn't cover all small businesses.

"Many small businesses that are not insured -- owners as well as employees -- prefer to go without insurance than to even try to pay for it," Henry said. "Many owners are not members of any organization, and because of that they're not benefiting from the collaboration and the buy that organizations make with health care organizations to bring down the cost to them."

Keeping Employees

Sean Moore is president of the Greater Meriden Chamber of Commerce, which counts 700 businesses, from large to smal, in its membership. "If you're a larger business, you have more negotiating power with insurance companies," he pointed out.

"One of the challenges small businesses have is balancing the cost and the coverage of insurance," he continued. "It's fairly easy to get insurance if you take a massively high deductible. The thing small businesses need most is more choices and better prices. Health insurance is a great retention program and ensures you've got a healthy workforce that's going to arrive at work every day."

He said most of the Chamber's member businesses do provide coverage, but it may include a big deductible, some of which can be covered by a health savings account or other financing method.

Moore said that health coverage is one of the top three concerns of his members, just behind the high cost of energy and the challenges of transporting goods and workers, issues that have surged to the top with spiking energy prices.

In what looks like a contradiction to other studies, one published in May 2008 by the Kauffman-RAND Institute for Entrepreneurship Public Policy claimed it found that, "Despite clear increases in health insurance costs and cost burden, there is no evidence that firms dropped coverage over the period analyzed. Health-insurance offer rates remained relatively stable from 2000 to 2005." The report goes on, "These findings suggest that firms, and ultimately their employees, were willing to shoulder the burden of rising health-insurance costs even if it meant giving up increases in wages.'

Rich Country, Poor Care

That's at odds with what small employers like Franceschi are discovering on the ground in New Haven.

Franceschi said she and her husband pay $1,300 a month for a plan that does not include dental and eye care. Every year she pays a cost of living increase and any increases associated with a change in their age bracket.

"I love the U.S.," she said. I'm a U.S. citizen and both my kids were born here. But I can't believe such a rich, smart country does not have better medical care."