The cost of health care sits atop the list of concerns for major Massachusetts employers heading into 2019, according one of the state’s leading business trade groups.

Associated Industries of Massachusetts said that 74 percent of employers who participated in its biennial issues survey from September to November identified the cost of health insurance as one of their top three priorities.

Health care beat out the availability of workforce (64 percent) and regulatory issues (53 percent) for the top spot.

John Regan, executive vice president for governor affairs, wrote in a blog post on AIM’s website that “several” of the 168 employers that took the survey expressed concern that the combination of business assessments to help pay for MassHealth and unemployment and minimum wage increases would hurt their ability to grow and create new jobs.

Concerns in the business community over the rising cost of health insurance in Massachusetts is nothing new. The Legislature tried to pass a bill last session to stabilize community hospitals and maintain cheaper options for patients to seek care, but negotiations between the House and Senate broke down.

AIM, citing data from the state’s Center for Health Information and Analysis, said that despite health care spending growing by only 1.6 percent from 2016 to 2017, small business premiums rose 6.9 percent in 2017 and deductibles, co-pays and other out-of-pocket expenses climbed 5.7 percent.

“AIM looks forward to addressing the health-cost issue on multiple fronts, from working with industry partners on health-plan design to resolving the employer MassHealth assessment to leading an employer effort to reduce unnecessary use of emergency rooms,” AIM Vice President Katie Holahan said in a statement.