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 into universal health insurance overage system, and mandating all individuals to sign up for health insurance coverage through a Qualified Health Plan (QHP's must be offer affordable and comprehensive coverage - either privately or public publicly funded health insurance). Here is a link to the complete text of the [http://obamacarefacts.com/wp-content/uploads/2014/10/obamacarebill.pdf PPACA and the Health Care and Education Reconciliation Act].

One important and commonly voiced concern with the Patient Protection and [[Affordable Care Act]] by the media and the bill’s adversaries is that “Obamacare” will kill [[Small Business]] [http://www.investors.com/liberal-study-finds-obamanomics-killed-the-american-entrepreneur/]. The visible Obamacare's effect of Obamacare on small businesses is not necessarily seen in the abandonment of plans to grow 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 and cutting of employee hours. According to a Gallup and Wells Fargo survey of 600 small business owners, conducted in 2012, 48% of small business owners point toward "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]. While the ACA may have caused a slowing or ceasing in small business hiring, the actual harm of Obamacare regulations and mandates to small businesses, however, depends entirely on what 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). Furthermore, while the cost of providing health care insurance has assuredly risen, health insurance premiums have been on the rise for many years [http://obamacarefacts.com/obamacare-small-business/]. </onlyinclude>

=='''How Still, while the ACA really affects may have caused a slowing or ceasing in small businesses'''==[[Image:piechart.jpg|250px|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/]size because the effects vary so greatly between firms of different compositions and sizes in their workforces (i.e. number of full time 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 mandates of According to the ACA are passed onto larger companies - firms , small businesses with larger fewer than 50 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 still 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 affected in a slightly more complicated way[http://www.forbes.com/sites/groupthink/2012/08/10/will-obamacare-help-or-hurt-small-businesses/2/#49ebac0f31e5].

Furthermore, while the cost of insurance premiums and plans have assuredly risen post-ACA, health insurance premiums have been increasing due to rising health care costs for many years (prior to the act's enactment) [http://obamacarefacts.com/obamacare-small-business/] [Imagehttp:firmsize//jhppl.jpg|250px|left]dukejournals.org/content/36/3/539.short].</onlyinclude>

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.   =='''Small Businesses with Fewer than 50 FTE'''==Despite all of the backlash the Patient Protection and 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: *Employers must requires employers to provide their employees with a Summary of Benefits and Coverage Disclosure Rules (SBC’s), a standard form that essentially explains to employees what their plan entails (noncompliance may result in a further penalty). *ACA institutes a cap on caps the maximum contribution an employee can make toward a flexible spending arrangement (at $2500),

*institutes a 90-day maximum waiting period for employees to provide health care coverage employees who are eligible, as well as penalties for surpassing exceeding the 90-day period.

* For for employers that sponsor self-insured plans, there is requires another required 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, potentially dis-incentivizing small businesses from expanding their labor force.  Firms that employ 50 or more workers and do not provide qualified health insurance coverage must pay a tax penalty of $2,000 for each uninsured employee beyond the first 30 employees. Furthermore, firms with more than 50 workers must contribute, at a minimum, 60 percent of the cost for employees' coverage. [http://www.ncpa.org/pub/st356]. This increased marginal cost for the 50th employee serves as a reason why many critics of the ACA believe that 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 than four out of ten small business owners have delayed hiring due to uncertainty about the effects of the ACA [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].

===Options for small businesses Companies with fewer than 50 to 100 FTE employees that still choose are required to provide health care===Although, health care is not a mandatory service for small businesses with fewer than 50 FTE many small businesses still provide health insurance for coverage to their employees. These companies, along but the penalties imposed for not complying with large companies, are seeing rising premiums on their insurance due to the ACA stipulation that health care requirements for these companies cannot deny coverage when considering an individual's healthwere delayed until 2016. However, there are options Companies with up to compensate with 100 FTE employees can purchase insurance through the increased (while also nonemployer-mandatory) cost of providing health careonly insurance exchanges, the most obvious of which would entail the end of employee-sponsored health insurance coverage were are run by small businesses or simply increasing the employee contribution to coverage. Small businesses can try to save on rising states; these exchanges could possibly result in lower 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 for small businesses by pooling customers [http://www.cnbcforbes.com/2015sites/groupthink/012012/08/510/will-smartobamacare-wayshelp-smallor-firmshurt-cansmall-slash-health-care-costs.htmlbusinesses/2/#49ebac0f31e5].

===Effect on Small Businesses with 50 and 99 employees===[[Image:healthcosts.jpg|250px|right]]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 dis-incentivizing small businesses from expanding their labor force. Firms that employ 50 or more workers and choose not to provide health insurance coverage must pay a tax penalty of $2,000 for each uninsured employee beyond the first 30. Furthermore, firms with more than 50 workers must contribute, at a minimum, 60 percent of the cost for individual minimum essential coverage. [http://www.ncpa.org/pub/st356]. This increased marginal cost we see for the 50th employee serves as the reason why many critics of the ACA believe that Obamacare is killing jobs, and also why many small business owners 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 than four out of ten small business owners "have delayed hiring due to uncertainty about the effects of the Affordable Care Act." One in five small business owners reported that they have cut their number of employees. The Society for Human Resource Management also found 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 employees are required to provide insurance, but the penalties imposed for not complying with the ACA requirements were delayed until 2016, while 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).

[[Image:SHOP.jpg|280px|right|]] The SHOP Marketplace or Exchange (Small Business Health Options Program, is a provision of the ACA designed to help small businesses get lower health insurance rates using group plans and also to claim tax credits. However the SHOP exchange did not open up to employers with less fewer than 50 FTE until 2015 and only just opened up in 2016 to businesses with 100 FTE or less. A SHOP allows for some increased employer choice functions, thus, enabling employers to choose from a larger field pool of available coverage options for its employees [http://digital.library.unt.edu/ark:/67531/metadc501935/m1/1/high_res_d/R43181_2015Jan15.pdf]. However, it is still unclear whether there is a The financial advantage in using of purchasing insurance trough the SHOP exchangesis uncertain, as insurers in the marketplace regardless will still be unable to cannot charge premiums based on 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 is increased buying power in the group-plan market (an advantage only larger firms used to possess), and the exchange also offers a simpler way to compare prices, coverage, and quality of plans [http://obamacarefacts.com/insurance-exchange/shop-exchange/].

There is also a temporary health insurance tax credit available to firms with 25 or fewer employees and making less than $50,000 in annual wages. However, but many firms do not meet the strict requirements necessary for obtaining the tax credit that would cover part up to 50% of the employer contributions for their to employees' health insurance premiums. To qualify for the small business tax credit, employers have (up to cover at least 5035% of employee-only health care coverage for every employee and purchase their insurance coverage through the SHOP Exchange. Additionally, there are further qualifications, such as 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 credit became available to firms in 2014 [http://obamacarefacts.com/insurance-exchange/shop-exchange/]. However, this tax credit is extremely under-inclusive, 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 tax credit, only 181,000 actually claimed the Small Employer Health Insurance Tax Credit in 2014. According to Holly Wade, director of research and policy analysis for the NFIB Research foundation, "The small business tax credit is a better talking point than it is a financial incentive for small businesses" [httpexempt employers)://www.bizjournals.com/bizjournals/washingtonbureau/2016/03/why-obamacares-tax-credits-failedsmall-businesses.html].

==*1) Firms must employ fewer than 25 full-time equivalent (FTE) employees*2) Have an average employee salary of less than $50,000 per year (adjusted for 2014 inflation rates)*3) Employer must pay for at least 50% of all FTE employees'''2016 Election Candidates’ Positions on premium costs *4) Employee Coverage must be through Qualified Health Plans, 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 ( "the smaller the business, the bigger the credit" [https://www.healthcare.gov/small-businesses/provide-shop-coverage/small-business-tax-credits//])*6) Employers cannot claim the tax credit for more than two consecutive and taxable years (starting in the ACA'''==first taxable year after 2014)

The three remaining Republican candidates health insurance tax credit became available to firms in the 2016 Presidential Election, Ted Cruz, John Kasich2014 [http://obamacarefacts.com/insurance-exchange/shop-exchange/]. After 2014, and Donald Trump are largely united on the issue maximum credit amount increases from 35% to 50% of health care reform in that they all have plans to appeal the Affordable Care Act if elected President, opting for free market tactics in the health insurance industry – allowing individuals and employers to continue to opt in or out ' share of privately offered health insurancepremiums. The Republican Candidates promise to expand coveragetax credit is quite under-inclusive, improve health care qualitythough, lower drug and other medical costsaccording to the National Federation of Independent Businesses, and even increase transparency only one in the health care market three small businesses qualify [httpshttp://ballotpediawww.ncpa.org/2016_presidential_candidates_on_healthcarepub/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 Small Employer Health Insurance Tax Credit in 2014.

Meanwhile on the other end of the political spectrum, Democratic Candidate Bernie Sanders goes so far as According to say that he wants to expand the ACA into a Medicaid-for-all systemHolly Wade, which could completely remove employer-sponsored health care from the equation. Democratic Candidate Secretary Hillary Clinton has been an advocate director of universal health care ever since she proposed her own health care reform plan in the 90’s research and is now running with policy analysis for the intention of defending and building upon NFIB Research foundation, "the ACA. In an interview with AOL.com on January 27, 2016, she expressed that“Health care small business tax credit is a basic right. We are 90 percent covered, we gotta get to 100 percent, and then we gotta get cost down and make better talking point than it work is a financial incentive 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 itsmall businesses" [httpshttp://ballotpediawww.orgbizjournals.com/bizjournals/2016_presidential_candidates_on_healthcarewashingtonbureau/2016/03/why-obamacares-tax-credits-failedsmall-businesses.html].

There remains a lot of uncertainty as to Uncertainty surrounds the specific effects effect 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 Considering the status quo and general trends of the health insurance market, the ACA seems it will most likely not turn out not to be the “job-killer” or “enemy of small business” it was predicted to be. And largely, there is while insurance premiums will continue to rise for the firms, which have to provide employer-sponsored health insurance to its employees, the bill should not significant evidence signaling that the ACA is devastating seriously harm small businesses and startups with fewer than 50 full time equivalent employees.