The small businesses that struggle the most with health insurance may be the smallest of all: those with only one employee.

In 11 states, self-employed people have some of the same legal rights as small companies when it comes to dealing with insurers: Colorado, Connecticut, Delaware, Florida, Maine, Massachusetts, Mississippi, New Hampshire, North Carolina, Rhode Island and Vermont.

But elsewhere, in dealing with insurance companies, the nation’s estimated 20 million self-employed are on their own.

In Virginia, a state with relatively few controls on insurance rates, Clay Williams, a 59-year-old self-employed real estate agent in Falls Church, said the cost of health insurance for himself, his wife and two sons, had tripled in six years. After it ballooned last year to $1,956 a month, he angrily refused to renew.