Vistage Small and Midsize Business CEO Survey Shows Economic Outlook Deteriorating as Healthcare, Financing and Operating Costs Squeeze Margins

SAN DIEGO, Oct. 19, 2026 /PRNewswire/ — Small and midsize business (SMB) CEOs’ confidence in the economy declined for the third consecutive quarter in Q3 2026, according to the latest CEO Confidence Index from Vistage, a CEO coaching and peer advisory organization. The Index dropped 3.4 points to 80.8, down from 84.2 last quarter.

Vistage’s latest survey found that economic sentiment has also weakened significantly from last quarter, with expectations for the year ahead falling the most. Business-level expectations are slightly more resilient, with 62% of CEOs still expecting revenue growth and 50% planning to expand their workforce. Still, mounting health care expenses amid open enrollment season and other rising costs are making it increasingly difficult to turn growth into profit.

“CEOs have struggled with economic uncertainty since the COVID pandemic and, more recently, with geopolitical instability,” said Joe Galvin, Vistage’s chief research officer. “Those concerns have now become reality, as growing inflation, higher interest rates, and the soaring price of energy translate into a vicious cycle of increased cost and compressed margins with no end in sight.”

Since 2003, Vistage has measured SMB CEOs’ sentiment on a variety of economic and business factors each quarter. ITR Economics’ rate-of-change methodology has confirmed the Vistage CEO Confidence Index is a leading indicator of the U.S. Industrial Production Index nine months in advance, providing a clear view into the future.

“When you look at all of the rising input costs, materials, labor, electricity and insurance, amid economic headwinds like high interest rates, it’s difficult to imagine a world in which margins don’t compress and we don’t face profitability struggles as we go into 2027,” said Eric Post, Deputy Chief Economist at ITR Economics. “We want to make sure businesses don’t over plan for what their top line can do in 2027 as the economy slows.”

Q3 2026 Vistage CEO Confidence Index highlights include:

Economic optimism falls as CEOs look ahead.

• 46% of CEOs report that U.S. economic conditions have worsened compared to last year, while only 14% say conditions have improved, down 5 percentage points from last quarter.
• Only 19% expect the economy to improve over the next year, down 10 percentage points from last quarter and 13 points below Q3 2025.
• 34% now expect conditions to worsen, up 8 points from last quarter.

CEO revenue expectations soften modestly, and a smaller proportion expect increased profits.

• 62% expect higher revenue (down 2 percentage points from last quarter), but only 47% expect higher profit, as rising costs eat into margins.
• 36% plan to increase fixed investments over the next year, down 2 percentage points from 38% last quarter.

Health care costs add to the squeeze as open enrollment nears.

• 74% of CEOs expect health care costs to rise by at least 6% next year, including 33% who expect increases above 10%.
• 71% plan to seek competitive bids on their health benefits plan, including 24% who plan to change providers or plans. Just 23% of CEOs prefer to keep their current plan without shopping around.
• CEOs are weighing alternatives such as self-insurance, captive insurance, level-funded plans, PEOs and ICHRAs, while balancing cost saving against recruiting and retention risks of reducing benefits or shifting more costs to employees.

CEOs adopt a defensive financial posture as rates rise.

• Analysis of open-ended responses revealed that CEOs are responding to elevated interest rates with the following strategies: 
  • Reducing debt and avoiding new borrowing
  • Building cash reserves and funding growth through operating cash flow
  • Applying tighter criteria to capital investments and acquisitions
  • Refinancing or locking in fixed rates

Hiring plans hold steady and AI Use Increases

• 50% plan to expand their workforce (same as last quarter), while 11% expect a decrease.
• 82% of CEOs report using generative AI themselves, up from 76% in Q4 2025. Only 3% say no one in their organization uses it.
• More than 70% of CEOs whose businesses support data centers or AI infrastructure expect that segment of their business to grow in the next 12 months.

Talent, costs, and customer hesitation remain a challenge.

• Analysis of open-ended responses revealed that CEOs’ top business challenges include finding and retaining qualified talent as well as rising costs for labor, fuel, insurance, materials, freight, and tariffs.
• Economic uncertainty is increasingly suppressing demand, with CEOs describing customers who delay, postpone or cancel orders and sales pipelines that are smaller and less reliable.

View the full results of the Q3 2026 Vistage CEO Confidence Index at: vistage.com/ceoindex.

About the Vistage CEO Confidence Index
Since 2003, the Vistage CEO Confidence Index has captured the sentiment of small and midsize business CEOs, presidents, and business owners in the United States about the economy each quarter. The Q3 2026 Vistage CEO Confidence Index survey was conducted online and sent to 9,443 active Vistage members participating in Chief Executive and Small Business groups. It was open between September 8 and 22, 2026, and captured input from 1,146 leaders.

Using ITR Economics’ rate-of-change methodology, analysis has revealed that the Vistage CEO Confidence Index is a leading indicator of the U.S. Industrial Production Index 9 months in advance. For more than 20 years, the Vistage CEO Confidence Index has been recognized as the definitive voice of high-performing, high-integrity leaders. As a trusted resource, the Index provides world-class insights to inform decision-making for CEOs and other key leaders of small and midsize businesses.

About Vistage Worldwide, Inc.
Vistage is the world’s largest CEO coaching and peer advisory organization. Since 1957 we’ve been guiding CEOs and owners of small and midsize businesses to greater success. It’s why Vistage member companies average 21+ years, while most U.S. businesses fail within five. Today, 45,000 members in 40 countries turn to Vistage to become better leaders who drive better outcomes. Learn more at www.vistage.com.

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SOURCE Vistage Worldwide, Inc.