Last year, the National Federation of Independent Business (NFIB) identified the top five concerns of borrowers. (The percentage of respondents who classified each as a “critical concern” is in parentheses below.) What differentiates strong borrowers from questionable ones is how they manage concerns such as these. Strong borrowers acknowledge key risks and take steps to prevent or mitigate their adverse effects.

1. Health care costs (52%)

In the midst of the Affordable Care Act’s implementation, it’s not surprising that health care tops the list of small business concerns. Starting on Jan. 1, 2015, employers with the equivalent of 100 or more full-time employees face potential penalties unless they offer certain levels of health insurance coverage. Companies with the equivalent of 50 to 99 full-time employees must report on their workers and coverage in 2015, but they won’t face potential penalties for not offering sufficient coverage until 2016.

The ACA is not entirely to blame for this ranking, however. Health care costs have been a top priority for small businesses every year in the 25-year history of the NFIB study. Even without the risk of penalties, many small companies voluntarily provide coverage to employees and their families — and the cost of that coverage is higher than ever. In fact, health care costs have more than doubled over the last decade, according to the NFIB.

Your borrowers can lower costs by shopping for health insurance from public and private sources. Borrowers with fewer than 50 full-time employees or the equivalent can ask their insurance agents and brokers about coverage through the government-run Small Business Health Options Program (SHOP) marketplace. The online version of SHOP is scheduled to be available for 2015, and the program will become available for companies with up to 100 full-time employees or the equivalent for 2016.

Some borrowers use other creative strategies to reduce the cost and hassle of providing coverage. For example, in lieu of offering insurance, some pay additional salary to help employees purchase their own health insurance. Sometimes, the additional salary combined with penalties for noncompliance will be less than the costs of company-sponsored plans.

2. Uncertainty over economic conditions (38%)

Coming off the heels of the biggest economic downturn since the Great Depression, small businesses are understandably gun-shy about the future of the economy. So far, the recovery has been painfully slow.

Macroeconomic conditions are largely outside the control of small businesses. One coping mechanism is to remain grounded. Caution is the name of the game. Watch out for borrowers that are overly optimistic when hiring, expanding facilities or building up inventory.

Monitor salary and rent expenses, fixed asset purchases and inventory levels for sudden spikes. These items can quickly deplete a borrower’s resources if the recovery suddenly stalls or temporarily reverses.

3. Energy costs, except electricity (35%)

Energy costs — including natural gas, propane, gasoline, diesel and fuel oil — have been unpredictable and skyrocketing in many industries and regions. Gasoline prices largely drive this ranking. The inflation-adjusted price of gasoline has risen from $1.75 per gallon to $3.70 per gallon over the last decade, according to the U.S. Department of Energy.

Evaluate utilities expenditures on your borrowers’ income statements and ask how they’re reducing their carbon footprints, especially in high-consumption industries, such as manufacturing and construction. Green practices can be as simple as lowering the thermostat during nonpeak hours or replacing vehicle fleets with more fuel-efficient models.

4. Uncertainty over government actions (35%); 5. Unreasonable government regulations (34%)

The last two concerns on the NFIB’s top five list relate to the current regulatory environment, which is in a state of policy upheaval for many industries. The financial and health care industries have recently been overhauled, and the government also plans to expand the scope of employment and environmental regulations.

Small business borrowers are often the hardest hit when the government changes its rules or simply fails to act. Liquidity can help minimize the adverse effects. Borrowers with a working capital cushion are generally better prepared to incur additional compliance costs or to weather a shutdown. Watch for borrowers with deteriorating quick ratios. This liquidity metric eliminates inventory, which is harder to convert to cash in a crisis.

Also talk to borrowers about the status of, and their anticipated responses to, pending regulatory actions. Strong borrowers are proactive, not reactive.

Concern for lenders

Strong borrowers will discuss their concerns openly and honestly. And they’ll have a plan in place to mitigate risks and exploit opportunities that emerge in the marketplace. Beware of borrowers who operate with blinders or downplay risk factors and potential threats.