Health care costs and the economy are the top factors affecting both employers' business decisions and their vote in the upcoming presidential election, according to a survey released today by the Principal Financial Group.

More than half of employers (57%) say health care costs are top of mind in regards to their business decisions, while slightly less (54%) cite economic growth. Other top issues include uncertainty of taxes (45%), gas prices (43%), unemployment (37%) and inflation (36%). The Principal group surveyed 604 business owners in companies of 10-500 employees.

American business owners say both the economy and health care reform will impact their votes in the presidential election, but the economics matter slightly more.

President Obama's Patient Protection and Affordable Care Act has been controversial, while many reports have attempted to understand the impact it will have on employers, all to different results. Challenger Mitt Romney has said he will repeal and replace the health reform law. Both candidates have very different views on how to best handle the struggling economy.

The main trouble with health reform is the looming uncertainty around it, employers say. In addition to worrying about managing the cost and administrative responsibilities of health care, employers say understanding the impact of health care reform on their business is their top concern for their well-being in the upcoming year.

Though the economy is a concern, businesses say they are doing fine, mainly because they are being frugal in their strategies.

Roughly half of those surveyed say their business financials improved compared to a year ago and more than half (58%) believe their financials will improve in the next 12 months. But when it comes to the broader picture, nearly half of those surveyed (46%) are cautious about the economic outlook for 2013, and two-thirds are holding off on making long-term financial commitments because of the current state of the economy.

“While owners of small to medium-sized businesses report growing confidence in what they can control—their own companies—they do so with a healthy dose of caution in the context of the overall economy,” says Amy Friedrich, Principal vice president. “As these owners prepare for Election Day, the economy will not only influence their vote, but also their long-term plans for spending.”

In an attempt to take control of the future of health care while curbing costs, more employers are turning to wellness programs. Nearly two-thirds of those surveyed (64%) offer some form of wellness benefit to their employees. Among those that do, almost one-third (32%) have experienced lower health insurance costs. They also say the programs have made their employees more productive at work, increased employee retention and caused them to be away less from work.

“With lingering ambiguity around health care reform, the challenge of managing health care costs can be overwhelming for owners of small and mid-sized businesses,” Friedrich says. “Business owners are seizing opportunities to take action amidst this uncertainty and experiencing positive results.”

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