Small business owners and managers face a lot of challenges — nearly as many, probably, as there are operations. But some challenges are more prevalent than others and some downright ubiquitous.

Every four years, the National Federation of Independent Business compiles a report on what are deemed the most pressing challenges of all. The small business advocacy group bases the report on the results of a survey that asks small business owners to rate 75 issues on a scale in which 1 constitutes a critical problem and seven isn’t a problem at all. The issues are ranked from top to bottom by their average scores.

The latest survey was conducted before the onset of the coronavirus pandemic in the United States and the economic downturn that followed — while one of the longest expansions in U.S. history was still under way, in fact. Regardless of whether times are bad or good, though, a lot of what small business owners identify as the biggest problems remain the same.

The cost of health insurance once again emerged as the No. 1 problem for small businesses in the latest survey results, a position the issue has held since 1986. More than half of small business owners responding to the latest survey rated the cost of health insurance as a critical problem.

Locating qualified employees came in second, up from 10th place in 2016. The ranking reflected what was before the pandemic historically low unemployment rates. Nearly a third of small business owners rated hiring as a critical problem.

Tax-related issues remain a concern, but one a smaller proportion of owners considered critical.

On the other hand, competition with large businesses moved from 31st to 21st in the latest survey results. It’s a trend that likely will continue in the aftermath of the pandemic after some small businesses were closed because of the pandemic even as larger operations remained opened.