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The Patient Protection and Affordable Care Act was passed by Congress and signed into law by President Obama on March 23, 2010. Together, the Health Care and Education Reconciliation Act of 2010 and the Affordable Care Act (ACA) transformed the existing healthcare system in the United States by instituting reforms to increase the quality, affordability, and accessibility of insurance coverage and expand Medicaid. [https://www.cbo.gov/topics/health-care/affordable-care-act]

==How can small businesses alleviate the rising costs of healthcare?==

Although small businesses that employ fewer than 50 full-time employees are not required to provide health insurance to their employees under the ACA, many do. These firms find themselves paying higher premiums as the cost of health insurance continues to rise. If small employers are unable or unwilling to pay the health premiums, they may be forced to discontinue their employer-sponsored healthcare coverage, and consequently, some workers might seek alternative employment to gain access to health coverage.

The SHOP (Small Business Health Options Program) Exchange, created by the ACA, provides another option for small businesses with fewer than 50 FTE employees. SHOP utilizes group plans and tax credits to offer lower healthcare costs and increased employer choice functions, by enabling employers to choose from a larger pool of available coverage options. [http://digital.library.unt.edu/ark:/67531/metadc501935/m1/1/high_res_d/R43181_2015Jan15.pdf]

==How has the ACA affected small business hiring practices?==

The more readily available effects of the ACA on small businesses are on employees. Some small businesses report slowing or halting their hiring practices and cutting employees’ hours. In 2012, two years after the introduction of the ACA, Gallup and Wells Fargo conducted a survey of 600 small business owners. The survey revealed that 48 percent of small business owners pointed to "potential healthcare costs" as a reason for not hiring more employees.[http://www.gallup.com/poll/152654/health-costs-gov-regulations-curb-small-business-hiring.aspx]

According to another survey conducted by the Society for Human Resource Management of more than 600 small business owners, more than four out of ten small business owners have delayed hiring due to uncertainty about the effects of the ACA. One in five small business owners reported that they have cut their number of employees.[http://www.ncpa.org/pub/st356]

However, the government delayed penalties for small businesses that employed between 50 and 99 employees until 2016, as a transitional relief from the employer mandate. In 2016, these small businesses will be for the first time subjected to the burden of the ACA’s employer mandates.

==Link to Google Doc==

14. http://www.ncpa.org/pub/st356