The rising cost of providing health insurance to employees remains the most pressing issue facing Massachusetts employers, a new AIM survey shows.

Three-quarters of the employers who participated in the association’s biennial Issues Survey from September to November identified the cost of health care as one of their three policy priorities. Other major challenges include work-force availability (64 percent), regulatory issues (53 percent) and the new paid family and medical leave law (51 percent).

AIM conducts the survey to solicit employer opinions on its policy agenda for the upcoming two-year session of the Massachusetts Legislature.

“AIM members understand the value of providing good health insurance to their employees, but employers are telling us clearly that they need relief from the relentless cost increases generated by the health-care system,” said Katie Holahan, Vice President of Government Affairs at AIM.

“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.”

One hundred sixty-eight employers participated in the AIM survey. The top 10 issues were:

1. The cost of health care ” 74 percent
2. The availability of work force ” 64 percent
3. Regulatory issues (including compliance) ” 53 percent
4. Paid family and medical leave ” 50 percent
5. State and local taxes ” 42 percent
6. Minimum wage & the cost of electricity (tie) ” 28 percent
7. Transportation & federal taxes (tie) ” 21 percent
8. Trade issues ” 15 percent
9. Education ” 12 percent
10. Housing ” 2 percent

Several employers expressed concern about the cumulative burden of government-imposed expenses ” including the $200 million MassHealth assessment, unemployment insurance and minimum-wage increases ” on their ability to grow and create jobs.

Health-insurance costs have been a dominant worry for Massachusetts employers for decades.

The Massachusetts Center for Health Information and Analysis (CHIA) reported in September that health care-spending in the commonwealth grew 1.6 percent from 2016 to 2017, with costs totaling $61.1 billion, or about $8,900 per resident.

While 2017 was the second consecutive year that overall growth came in below the 3.6 percent benchmark set by the Health Policy Commission, small-business premiums rose on average 6.9 percent. Deductibles, co-pays, co-insurance and other out-of-pocket expenses were up 5.7 percent.

Contact John Regan at jregan@aimnet.org.