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 a 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 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]. So 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 heavily on small business size because the effect of Obamacare on small businesses varies so 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 Still, while the SBA has established ACA may have caused a summary slowing or ceasing in small business hiring practices, the exact harm of the size guidelines for Obamacare regulations and mandates to small businesses to qualify "as a depends heavily on small business concern for SBA and most other federal programs" [https://www.sba.gov/contracting/getting-started-contractor/make-sure-you-meet-sba-size-standards/summary-size-standards-industry-sector] (500 employees for mining and manufacturing businesses and an annual receipt of $7.5 in average annual receipts for non-manufacturing firms), because the specifications effects vary so greatly between industryfirms of different compositions and sizes in their workforces (i. Alsoe. number of full time employees, while United States has almost 6 million small businesses that fall under these size restrictionsaverage wages, 90% state of these businesses employ fewer than 20 people [http://obamacarefacts.com/obamacare-small-business/]operation).

FurthermoreThe SBA 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-started-contractor/make-sure-you-meet-sba-size-standards/summary-size-standards-industry-sector] (500 employees for mining and manufacturing businesses or an annual receipt of $7.5 million in average annual receipts for non-manufacturing firms), while the cost of providing health care insurance but these small business standards vary between industries. The United States has assuredly risen since the ACA'S enactmentalmost 6 million small businesses that fall under small business size classifications; however, health insurance premiums had already been increasing for many years 90% of 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://jhpplfiles.dukejournalskff.org/contentattachment/36/3/539.shortreport-2015-employer-health-benefits-survey]. </onlyinclude>

=='''How According to the ACA really affects , small businesseswith fewer than fifty full-time equivalent employees are exempt from the employer mandate. At the time of the ACA'''==S enactment in 2012, only 200,000 small businesses would have been affected by the employer mandate, as 96% of the small businesses employed fewer than 50 employees [[Imagehttp:piechart//www.jpg|250px|right]forbes.com/sites/groupthink/2012/08/10/will-obamacare-help-or-hurt-small-businesses/2/#49ebac0f31e5].

The Affordable Care Act uses Furthermore, while the language “fullcost of insurance premiums and plans have assuredly risen post-time equivalent” ACA, health insurance premiums have been increasing due to rising health care costs for many years (abbreviated FTEprior to the act's enactment)[http://obamacarefacts. Calculation for finding the number of fullcom/obamacare-small-time equivalent employeesbusiness/] [http: //jhppl.dukejournals.org/content/36/3/539.short].(total number of full-time employees + the combined number of part-time employees hours)</ 30. onlyinclude>

=='''The employer mandate of the ACA is passed onto larger companies - firms with larger than 50 FTE (full time equivalent employees) - but many of these larger corporations also already offer health insurance coverage for their employees. However, companies between 50 and 100 FTE, which are still required by the ACA to offer health insurance coverage to their employees, have been affected in a more complicated way. Small Business'''==

==Small businesses with fewer than 50 FTE==Despite all of the backlash the Patient Protection and The Affordable Care Act, or Obamacare, has received for its perceived potential destruction on small businesses, for uses the most part, small businesses with under 50 full terminology “full-time employees are not greatly burdened by equivalent” (abbreviated FTE) when calculating the ACA. In fact, companies with fewer than 50 employees, which make up a large portion number of small businesses, are not penalized at all for not providing health care to their full-time employees.

Thus, if employers with fewer than 50 FTE find themselves unable or unwilling to accommodate Calculation for finding the rising costs number of health care, they can simply opt out full-time equivalent employees: # of providing employeeFTE's = '''Total Number of Full-sponsored health insurance. Those who do decide to provide employertime Employees''' + '''[Combined Number of Part-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 ACA.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 [[Imagehttps:Penalty//www.healthcare.jpg|250px|right|]gov/shop-calculators-fte/#].

Another criterion for determining mandate-exemption or tax-credit status is the average annual wage of employees: '''Average Annual Wage ===Regulations that affect Total Wages Paid by an Employer '''/''' Number of FTEs''', rounding down to the nearest $1,000 [http://obamacarefacts.com/obamacare-small businesses with fewer than 50 FTE===-business/]. Although The employer mandate of the ACA applies to relatively larger small businesses - firms with fewer greater than 50 FTE employees are not mandated by the ACA for to provide - but many of these larger businesses offer health care insurance to its coverage for their employees, there are some additional regulations and provisions associated with the ACA that increase the cost of providing and receiving health care for firms that do choose to do soalready. The ACA:

=='''Small Businesses with Fewer than 50 FTE'''=Options =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 that still choose , 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===Althoughsmall 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 for to their employees. These companies, along with large companies, are seeing rising premiums steeper premium prices on their insurance due to the ACA stipulation that health care companies cannot deny or charge coverage when considering based on an individual's healthor risk factors, pre-existing conditions, or sex. 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 are opting out and increasing the employee employees' contribution to coverage. Small businesses can try to save on rising health care costs in various ways(if possible), such as include:

*negotiating on private insurance plansplan prices

===Small Businesses with 50 and 99 employees===[[Image:healthcosts.jpg|250px|right]]Small businesses with fewer than 50 FTE are exempt from the penalties While some of ACA; howeverthese options may be accompanied by risks, they can serve 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 cheaper employer coveragealternatives. [http://www.ncpacnbc.orgcom/2015/01/pub08/st3565-smart-ways-small-firms-can-slash-health-care-costs.html]. This increased marginal cost we see for the 50th employee serves as the 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 ===Increased Marginal Cost 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 50th Employee===Small businesses are reducing workers' hours to part time because they are not required to offer coverage for employees who work less with fewer than 30 hours per week. These part-time employees 50 FTE are eligible for subsidized coverage in the new health insurance exchanges offered through exempt from the penalties of ACA [http://www.ncpa.org/pub/st356].Companies with between 50 to 99 employees are required to provide insurance; however, but the penalties imposed for not complying with as soon as a company reaches the ACA requirements were delayed until 201650th employee mark, while the penalty for companies with hire becomes much more than 99 employees was delayed until 2015. As a result of these delaysexpensive, it is not entirely possible to fully understand and analyze the exact effects of the ACA on potentially dis-incentivizing small businesses that are required to provide health insurance to its employeesfrom 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'''SHOP Exchange'''==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 [[Imagehttp:SHOP//www.jpg|280px|right|]ncpa.org/pub/st356].

The SHOP Marketplace or Exchange (Small Business Health Options Program, is a provision of the ACA designed Companies with 50 to 100 FTE employees are required to help small businesses get lower provide health insurance rates using group plans and also coverage to claim tax credits. The SHOP exchange did their employees, but the penalties imposed for not open up to employers complying with less than 50 FTE the ACA requirements for these companies were delayed until 2015 and only just opened 2016. Companies with up in 2016 to businesses with 100 FTE or less. SHOP allows for increased employees can purchase insurance through the employer choice functions, enabling employers to choose from a larger field of available coverage options for employees [http://digital.library.unt.edu/ark:/67531/metadc501935/m1/1/high_res_d/R43181_2015Jan15.pdf]. However-only insurance exchanges, were are run by the financial advantage states; these exchanges could possibly result in using the SHOP exchange is uncertain, as insurers in the marketplace regardless will still not be allowed to charge premiums based on lower health status, and workers using the SHOP exchanges, will become ineligible care costs for subsidies when they buy their own insurance small businesses by pooling customers [http://www.ncpaforbes.orgcom/pubsites/st356]. What SHOP does 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:groupthink/2012/08/obamacarefacts.com10/insurancewill-obamacare-help-or-hurt-small-exchangebusinesses/shop-exchange2/#49ebac0f31e5].

===Small Employer Health Insurance Tax Credit=== There is also a temporary health insurance tax credit available to firms The employer mandate penalty for companies with 25 or fewer more than 99 employees and making less than $50,000 was delayed until 2015. With all of the delays in annual wagespenalties, but many firms do not meet it is difficult to fully understand and analyze the strict requirements necessary for obtaining exact effects of the tax credit ACA on small businesses (especially those that would cover part of are required by the employer contributions for their employees' law to provide health insurance premiumsto its employees).

To qualify for =='''SHOP Exchange'''==The SHOP Marketplace or Exchange (Small Business Health Options Program, is a provision of the ACA designed to get small business businesses lower health insurance rates using group plans and tax credit, employers have to cover at least 50% of credits for providing employee-only sponsored health care coverage for every employee and purchase their insurance coverage through the SHOP Exchange. Additionally, only employers with 10 or fewer FTE with annual wages of less than $10,000 can qualify for the full tax credit that covers up to 50% of their share of employee premiums.

The health insurance tax credit became available SHOP exchange did not open up to firms employers with fewer than 50 FTE until 2015 and only just opened up in 2014 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://obamacarefactsdigital.library.unt.comedu/ark:/67531/metadc501935/m1/insurance-exchange1/shop-exchangehigh_res_d/R43181_2015Jan15.pdf]. The tax credit financial advantage of purchasing insurance trough the SHOP exchanges is incredibly under-inclusiveuncertain, as insurers in the marketplace cannot charge premiums based on health status, and according to workers using the National Federation of Independent BusinessesSHOP exchanges, only one in three small businesses qualify will become ineligible for subsidies when they buy their own insurance [http://www.ncpa.org/pub/st356]. Of the estimated 1.4 to 4 million What SHOP does offer small businesses that were eligible for is increased buying power in the wide range of tax creditsgroup-plan market (an advantage only larger firms used to possess) and a simpler way to compare prices, only 181coverage,000 actually claimed the Small Employer Health Insurance Tax Credit in 2014and quality of plans [http://obamacarefacts.com/insurance-exchange/shop-exchange/].

According ===Small Employer Health Insurance Tax Credit=== There is also a temporary health insurance tax credit available to Holly Wadefirms with 25 or fewer employees and making less than $50,000 in annual wages. However, many firms do not meet the director of research and policy analysis strict requirements necessary for obtaining the NFIB Research foundation, "the small business tax credit is a better talking point than it is a financial incentive that would cover up to 50% of employer contributions to employees' health insurance premiums (up to 35% for small businesses" [http://www.bizjournals.com/bizjournals/washingtonbureau/2016/03/why-obamacares-tax-credits-failedsmall-businesses.html].exempt employers):

==*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.