Companies’ shift away from providing major medical may be about to accelerate.

When researchers surveyed 1,041 owners and decision-makers at small and midsize businesses in January and February for a unit of PNC Financial Services Group Inc., Pittsburgh, 66% said rising health care costs have been having a moderate or severe impact on salary increases, and 57% said they were “likely to reduce benefits of their employees in the future,” PNC says.

When researchers asked the employers about which issue they would most like to see addressed in the upcoming mid-term elections, 18% said tax reform, 23% said reducing U.S. reliance on foreign energy sources, and 25% said health care.