Changes

<onlyinclude>[[Image:obama's signature.jpg|250px|right]] The Patient Protection and Affordable Care Act was passed by Congress and signed into law by President Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act Amendmentof 2010, the law completely replaced the existing health care system in the United States, by expanding Medicaid and Medicare, and mandating universal all individuals to sign up for health insurance overage, whether coverage through a Qualified Health Plan (QHP's must be offer affordable and comprehensive coverage - either privately or public publicly funded). One important concern with Here is a link to the complete text of the Patient Protection [http://obamacarefacts.com/wp-content/uploads/2014/10/obamacarebill.pdf PPACA and [[Affordable the Health Care and Education Reconciliation Act]] by the media and the bill’s adversaries is that “Obamacare” will kill [[Small Business]].

While One concern with the ACA has negatively impacted some small businesses, the actual harm of Obamacare regulations Patient Protection and mandates to small businesses, however, depends entirely on what [[Affordable Care Act]] is considered a small business. The effect of Obamacare on small businesses varies vastly between firms of different composition and size within their workforces (i.e. number of full time employees, average wages, state where the business is operated). While the cost of providing health care insurance has assuredly risen, health insurance premiums have been on the rise for many years that “Obamacare” will kill [[Small Business]] [http://obamacarefactswww.investors.com/obamacareliberal-study-finds-smallobamanomics-killed-the-american-businessentrepreneur/]. The visible Obamacare's effect of Obamacare on small businesses is not necessarily seen in the abandonment of plans to grow a business businesses or death of businesses themselves, but, rather, in the a slowing or decrease halting in hiring of , as well as a cut in employees hours. According to a Gallup and cutting Wells Fargo survey of 600 small business owners conducted in 2012, 48% of employee hourssmall business owners point toward "potential healthcare costs" as a reason for not hiring more employees [http://www.gallup. <com/onlyinclude>poll/152654/health-costs-gov-regulations-curb-small-business-hiring.aspx].

=='''How Still, while the ACA really affects may have caused a slowing or ceasing in small businesses'''==[[Image:piechart.jpg|200px|right]]The United States has almost 6 million small businessesbusiness hiring practices, the exact harm of Obamacare regulations and 90% of these mandates to small businesses employ fewer than 20 people [http://obamacarefacts.com/obamacare-depends heavily on small-business/]. And largely, there is not significant evidence signaling that size because the ACA is devastating small businesses effects vary so greatly between firms of different compositions and startups with fewer than 50 sizes in their workforces (i.e. number of full time equivalent employees, average wages, state of operation).

The Affordable Care Act uses the language “fullSBA has established a summary of size guidelines for small businesses to qualify "as a small business concern for SBA and most other federal programs" [https://www.sba.gov/contracting/getting-time equivalent” (abbreviated FTE); a fullstarted-contractor/make-sure-you-meet-sba-size-standards/summary-size-time equivalent employee is the total number of fullstandards-time employees plus the combined number of partindustry-time sector] (500 employees hours divided by 30. Another criterion for determining mandate-exemption mining and manufacturing businesses or tax-credit status in the ACA is the average an annual wage receipt of employees; $7.5 million in average annual wage of a receipts for non-manufacturing firms), but these small business standards vary between industries. The United States has almost 6 million small businesses that fall under small business is calculated by dividing the total wages paid by an employer by the number size classifications; however, 90% of FTEs, rounding down to the nearest $1,000 small businesses employ fewer than 20 people [http://obamacarefacts.com/obamacare-small-business/].More precisely, 61% of firms have between 3 and 9 employees, while 98% of firms employ between 3 and 199 employees. [http://files.kff.org/attachment/report-2015-employer-health-benefits-survey]

Most of the harms of According to the ACA, thus, are passed onto larger companies - firms small businesses with larger fewer than 100 FTE (fifty full -time equivalent employees) - but many are exempt from the employer mandate. At the time of these larger corporations also already offer health insurance coverage for their employees. Howeverthe ACA'S enactment in 2012, companies between 50 and 100 FTEonly 200, which are required 000 small businesses would have been affected by the ACA to offer health insurance coverage to their employer mandate, as 96% of the small businesses employed fewer than 50 employees, are implicated in a slightly more complex way[http://www.forbes.com/sites/groupthink/2012/08/10/will-obamacare-help-or-hurt-small-businesses/2/#49ebac0f31e5].

===For small businesses with fewer than 50 employees===Despite all of the backlash the Patient Protection and Affordable Care Act, or ObamacareFurthermore, has received for its perceived potential destruction on small businesses, for the most part, small businesses with under 50 full time employees are not greatly devastated by while the Act. In fact, companies with fewer than 50 employees, which make up a large portion cost of small businessesinsurance premiums and plans have assuredly risen post-ACA, are not penalized at all for not providing health care to their employees. Thus, if employers with less than 50 FTE find themselves unable or unwilling insurance premiums have been increasing due to accommodate the rising costs of health care, they can simply opt out of providing employeecosts for many years (prior to the act's enactment) [http://obamacarefacts.com/obamacare-small-sponsored health insurancebusiness/] [http://jhppl.dukejournals.org/content/36/3/539. Those who do decide to provide employer-sponsored health insurance will have to deal with the issue of rising premiums and other slightly increased regulations, as a result of the comprehensive and affordable minimum coverage plan quality accepted by the ACAshort].</onlyinclude>

===Options for small businesses with fewer than 50 employees that still provide health care='''The ACA and Small Business'''==Although, health care is not a mandatory service for small businesses with fewer than 50 FTE many small businesses still provide health insurance for their employees. These companies, along with large companies, are seeing rising premiums on their insurance due to the ACA stipulation that health care companies cannot deny coverage when considering an individual's health. However, there are options to compensate with the increased (while also non-mandatory) cost of providing health care, the most obvious of which would entail the end of employee-sponsored health insurance coverage by small businesses or simply increasing the employee contribution to coverage. Small businesses can try to save on rising health care costs in various ways, such as participating in the SHOP Exchange, negotiating on private insurance plans, converting their employee group plans into individual employer-sponsored plans, such as Health Savings Accounts or Health Reimbursement Accounts (HSA’s and HRA’s), switching to direct primary care, or using Workplace Wellness Programs [http://www.cnbc.com/2015/01/08/5-smart-ways-small-firms-can-slash-health-care-costs.html].

 The Affordable Care Act uses the terminology “full-time equivalent” (abbreviated FTE) when calculating the number of full-time employees.  Calculation for finding the number of full-time equivalent employees: # of FTE's ='''Total Number of Full-time Employees''' + '''[Combined Number of Part-time Employees Hours ''')/''' 30]''' A full-time employee is any employee who worked on average more than 30 hours a week for 120 days or more in a year [https://www.healthcare.gov/shop-calculators-fte/#]. Another criterion for determining mandate-exemption or tax-credit status is the average annual wage of employees: '''Average Annual Wage = Total Wages Paid by an Employer '''/''' Number of FTEs''', rounding down to the nearest $1,000 [http://obamacarefacts.com/obamacare-small-business/]. The employer mandate of the ACA applies to relatively larger small businesses - firms with greater than 50 FTE employees - but many of these larger businesses offer health insurance coverage for their employees already.   ==Between '''Small Businesses with Fewer than 50 FTE'''==Despite all of the backlash the Patient Protection and 99 Affordable Care Act, or Obamacare, has received for its perceived potential destruction of small businesses, for the most part, small businesses with under 50 full time equivalent employees are not unavoidably burdened by the ACA. In fact, companies with fewer than 50 FTE, which make up a large portion of small businesses, are not penalized at all for choosing not to provide employer-sponsored health care. If employers with fewer than 50 FTE find themselves unable or unwilling to accommodate the rising costs of health care, they can simply opt out of providing employer-sponsored health insurance. Those who do decide to provide employer-sponsored health insurance will face the rising premiums and increased regulation, as a result of the ACA's minimum standards for Qualified Health Plans (increased comprehensiveness and affordability). ===Regulations on Health Care Coverage===Although small businesses with fewer than 50 employees are not mandated by the ACA for to provide health care insurance to its employees, there are additional regulations and provisions associated with the ACA that increase the cost of providing health insurance for the firms that do choose to do so. The ACA: *requires employers to provide their employees with a Summary of Benefits and Coverage Disclosure Rules (SBC’s), a standard form that explains to employees what their plan entails (noncompliance may result in a further penalty). *caps the maximum contribution an employee can make toward a flexible spending arrangement at $2500*increases Medicare withholdings on employees with wages over $200,000 and $250,000 for married joint filers*assesses net investment income for Medicare (taxable capital gains, dividends, rents, royalties, and interests) for single filers with a Modified Adjusted Gross Income of $200,000 for a single filer (and $250,000 for married joint filers)*institutes a 90-day maximum waiting period for employees to provide health care coverage employees who are eligible, as well as penalties for exceeding the 90-day period. *incentivizes employers, using inducements, such as as subsidies on health insurance plans, to offer Workplace Wellness Programs that satisfy the federally accepted requirements. * for employers that sponsor self-insured plans, requires another information reporting that is separate from the information reporting required for employers with more than 50 FTE [https://www.sba.gov/content/employers-with-up-to-50-employees]. ===Options for Small Businesses===Health care is not a mandatory service for small businesses with fewer than 50 FTE, but many small businesses still provide health insurance to their employees. These companies, along with large companies, are seeing steeper premium prices on their insurance due to the ACA stipulation that health care companies cannot deny or charge coverage based on an individual's health or risk factors, pre-existing conditions, or sex. However, options to compensate with the increased cost of providing health care, the most obvious of which are opting out and increasing employees' contribution (if possible), include: *participating in the SHOP Exchange*negotiating on private insurance plan prices*converting their employee group plans into individual employer-sponsored plans, such as Health Savings Accounts or Health Reimbursement Accounts (HSA’s and HRA’s)*switching to direct primary care*using Workplace Wellness Programs  While some of these options may be accompanied by risks, they can serve as cheaper employer coverage alternatives. [http://www.cnbc.com/2015/01/08/5-smart-ways-small-firms-can-slash-health-care-costs.html]. ===Increased Marginal Cost for 50th Employee===Small businesses with fewer than 50 FTE are exempt from the penalties of ACA; however, as soon as a company reaches the 50th employee mark, the hire becomes much more expensive, possibly potentially dis-incentivizing small businesses from expanding their labor force.  Firms that employ 50 or more workers and choose do not to provide qualified health insurance coverage must pay a tax penalty of $2,000 for each uninsured employee beyond the first 30employees. Furthermore, firms with more than 50 workers must contribute, at a minimum, 60 percent of the cost for individual minimum essential employees' coverage. [http://www.ncpa.org/pub/st356]. This increased marginal cost we see for the 50th employee serves as the a reason why many critics of the ACA believe that Obamacare the ACA is killing jobs, and also why many small business owners may have concerns about expanding their businesses.  According to a survey conducted by the Society for Human Resource Management of more than 600 small business owners, more :*More than four out of ten small business owners "have delayed hiring due to uncertainty about the effects of the Affordable Care ActACA [http://www.ncpa.org/pub/st356]." *One in five small business owners reported that they have cut their number of employees[http://www.ncpa. org/pub/st356] The Society for Human Resource Management 's study also found that about one in five small businesses are reducing workers' hours to part time because they are not required to offer coverage for employees who work less than 30 hours per week. These part-time employees are eligible for subsidized coverage in the new health insurance exchanges offered through the ACA [http://www.ncpa.org/pub/st356]. Companies with between 50 to 99 100 FTE employees are required to provide health insurancecoverage to their employees, but the penalties imposed for not complying with the ACA requirements for these companies were delayed until 2016. Companies with up to 100 FTE employees can purchase insurance through the employer-only insurance exchanges, while were are run by the states; these exchanges could possibly result in lower health care costs for small businesses by pooling customers [http://www.forbes.com/sites/groupthink/2012/08/10/will-obamacare-help-or-hurt-small-businesses/2/#49ebac0f31e5]. The employer mandate penalty for companies with more than 99 employees was delayed until 2015. As a result With all of these the delaysin penalties, it is not entirely possible difficult to fully understand and analyze the exact effects of the ACA on small businesses (especially those that are required by the law to provide health insurance to its employees).

The SHOP exchange did not open up to employers with fewer than 50 FTE until 2015 and only just opened up in 2016 to businesses with 100 FTE or less. SHOP allows for increased employer choice functions, enabling employers to choose from a larger pool of available coverage options for employees [http://digital.library.unt.edu/ark:/67531/metadc501935/m1/1/high_res_d/R43181_2015Jan15.pdf] The financial advantage of purchasing insurance trough the SHOP exchanges is uncertain, as insurers in the marketplace cannot charge premiums based on health status, and workers using the SHOP exchanges, will become ineligible for subsidies when they buy their own insurance [Imagehttp://www.ncpa.org/pub/st356]. What SHOPdoes offer small businesses is increased buying power in the group-plan market (an advantage only larger firms used to possess) and a simpler way to compare prices, coverage, and quality of plans [http://obamacarefacts.jpg|280px|right|]com/insurance-exchange/shop-exchange/].

The SHOP Marketplace or Exchange (===Small Business Employer Health Options Program, Insurance Tax Credit=== There is also a provision of the ACA designed to help small businesses get lower temporary health insurance rates using group plans and also to claim tax credits. However the SHOP exchange did not open up credit available to employers firms with 25 or fewer employees and making less than $50 FTE until 2015 and only just opened up ,000 in 2016 to businesses with 100 FTE or less. A SHOP allows for some employer choice functions, thus, enabling employers to choose from a larger field of available coverage options for its employees [http://digital.library.unt.edu/ark:/67531/metadc501935/m1/1/high_res_d/R43181_2015Jan15.pdf]annual wages. However, it is still unclear whether there is a financial advantage in using many firms do not meet the SHOP exchanges, as insurers in strict requirements necessary for obtaining the marketplace regardless will still be unable tax credit that would cover up to charge premiums based on 50% of employer contributions to employees' health status, and workers using the SHOP exchanges, will become ineligible for subsidies when they buy their own insurance [http://www.ncpa.org/pub/st356]. What the SHOP program does do, however, is offer small businesses increased buying power in the group-plan market premiums (an advantage only larger firms used up to possess35% for tax-exempt employers), and the exchange also offers a simpler way to compare prices, coverage, and quality of plans [http://obamacarefacts.com/insurance-exchange/shop-exchange/].

===Tax Credit=== There is a temporary health insurance tax credit available to firms with *1) Firms must employ fewer than 25 or fewer full-time equivalent (FTE) employees and making *2) Have an average employee salary of less than $50,000 in annual wages, but many firms will not meet the strict requirements necessary per year (adjusted for obtaining the generous tax credit. To qualify 2014 inflation rates)*3) Employer must pay for the small business tax credit, employers have to cover at least 50% of employee-only health care coverage for every employee. Additionallyall FTE employees' premium costs *4) Employee Coverage must be through Qualified Health Plans, there are further stipulations and qualifications, such as purchased through the SHOP Marketplace*5) Only employers with 10 or fewer FTE with annual wages of less than $10,000 can qualify for the full tax credit for up to 50% of their share of employee premiums. The health insurance tax ( "the smaller the business, the bigger the credit became available to firms in 2014 " [httphttps://obamacarefactswww.healthcare.comgov/insurancesmall-exchangebusinesses/provide-shop-exchangecoverage/small-business-tax-credits//]. However, this )*6) Employers cannot claim the tax credit is extremely under-inclusive, for more than two consecutive and according to taxable years (starting in the National Federation of Independent Businesses, only one in three small businesses qualify [http://www.ncpa.org/pub/st356].first taxable year after 2014)

==The health insurance tax credit became available to firms in 2014 [http://obamacarefacts.com/insurance-exchange/shop-exchange/]. After 2014, the maximum credit amount increases from 35% to 50% of employers'''2016 Election Candidates’ Positions on share of premiums. The tax credit is quite under-inclusive, though, and according to the National Federation of Independent Businesses, only one in three small businesses qualify [http://www.ncpa.org/pub/st356]. Of the estimated 1.4 to 4 million small businesses that were eligible for the wide range of tax credits, only 181,000 actually claimed the ACA'''==Small Employer Health Insurance Tax Credit in 2014.

The four remaining Republican candidates in the 2016 Presidential Election, Ted Cruz, John Kasich, Marco RubioAccording to Holly Wade, and Donald Trump are largely united on the issue director of health care reform in that they all have plans to appeal the Affordable Care Act if elected President, opting research and policy analysis for free market tactics in the health insurance industry – allowing individuals and employers to continue to opt in or out of privately offered health insurance. The Republican Candidates promise to expand coverage, improve health care qualityNFIB Research foundation, lower drug and other medical costs, and even increase transparency in "the health care market small business tax credit is a better talking point than it is a financial incentive for small businesses" [httpshttp://ballotpediawww.bizjournals.orgcom/bizjournals/washingtonbureau/2016_presidential_candidates_on_healthcare2016/03/why-obamacares-tax-credits-failedsmall-businesses.html].

Meanwhile on the other end of the spectrum, Democratic Candidate Bernie Sanders actually goes so far as to say that he wants to expand the ACA into a Medicaid-for-all system, which could completely remove employer-sponsored health care from the equation. Democratic Candidate Secretary Hillary Clinton has been an advocate of universal health care ever since she proposed her own health care reform plan in the 90’s and is now running with the intention of defending and building upon the ACA. In an interview with AOL.com on January 27, 2016, she expressed that“Health care is a basic right. We are 90 percent covered, we gotta get to 100 percent, and then we gotta get cost down and make it work for everybody. And even though we didn=='t get it then, we've got it now and I'm going to defend it and improve it" [https://ballotpedia.org/2016_presidential_candidates_on_healthcare].Conclusion'''==

There remains a lot of uncertainty as to the specific effects of the ACA on small businesses because of the many delays and exemptions in the rollout process and implantation of the ACA’s mandates and provisions. By extrapolating from the status quo and general trends of the health insurance market, the ACA will most likely not turn out to be the “job-killer” or “enemy of small business” it was predicted to be.In fact, the head of the CBO Douglas Elmendorf said, “We don’t think that the healthcare law is having a significant impact on the economy today… It would reduce the amount of labor used in the economy by about a half a percent at the end of the decade… but, most of that is people choosing not to work because they can obtain health insurance at an affordable price outside of the workforce” [http://obamacarefacts.com/obamacare-small-business/]. John Arensmeyer, founder and CEO of the Small Business Majority, even went so far as to say in in a statement, reported by Fox News, said that

==EndnotesReferences==1. [http://www.gallup.com/poll/152654/health-costs-gov-regulations-curb-small-business-hiring.aspx Gallup] 2. [http://obamacarefacts.com/obamacare-small-business/ Obamacarefacts] 3. [http://obamacarefacts.com/obamacare-small-business/ Obamacarefacts] 4. [http://obamacarefacts.com/obamacare-small-business/ Obamacarefacts]

15. [httphttps://obamacarefactswww.comsba.gov/obamacarecontent/employers-with-up-smallto-business/ Obamacarefacts50-employees SBA]

26. [http://obamacarefactswww.cnbc.com/obamacare2015/01/08/5-smart-ways-small-business/ Obamacarefactsfirms-can-slash-health-care-costs.html CNBC]

37. [http://www.ncpa.org/pub/st356 NCPA] 8. [http://www.ncpa.org/pub/st356 NCPA] 8. [http://digital.library.unt.edu/ark:/67531/metadc501935/m1/1/high_res_d/R43181_2015Jan15.pdf Congressional Research Service] 10. [http://www.ncpa.org/pub/st356 NCPA] 11. [http://obamacarefacts.com/obamacareinsurance-smallexchange/shop-businessexchange/ Obamacarefacts] 12. [http://obamacarefacts.com/insurance-exchange/shop-exchange/ Obamacarefacts] 13. [http://www.ncpa.org/pub/st356 NCPA]

414. [https://wwwballotpedia.sba.gov/contentorg/employers-with-up-to-50-employees SBA2016_presidential_candidates_on_healthcare Ballotpedia]

515. [httphttps://wwwballotpedia.cnbc.comorg/2015/01/08/5-smart-ways-small-firms-can-slash-health-care-costs.html CNBC2016_presidential_candidates_on_healthcare Ballotpedia]

6. [http[Category: Public]][[Public Classification:://www.ncpa.org/pub/st356 NCPALegislation| ]]