The Affordable Care Act: Answers and Resources for Small Businesses



  • Companies with fewer than 50 employees will not be required by law to offer health insurance, but they can choose to opt in
  • The ACA sets community-based rates, meaning small businesses will have access to cheaper insurance than they do now
  • Starting in 2014, companies with less than 26 employees can claim a tax credit of up to 50 percent of premium costs

This article originally appeared on the Texas CEO Magazine website.

According to a 2010 survey by the Kaiser Family Foundation, 99 percent of all employers with 200 or more employees offered health insurance to their employees. However, only 59 percent of all employers with fewer than ten employees offered health insurance. The provisions of the Affordable Care Act (ACA) taking effect in 2014 will not only provide individuals with more health insurance options, but will also make it possible for small businesses to provide health insurance for employees without bearing a large cost premium for their small size. Since companies with 50 or more full-time employees will be required to offer health insurance and will have access to different resources than smaller businesses, here are issues that will impact firms with fewer than 50 employees.

Benefits of Offering Health Insurance

While small businesses with fewer than 50 employees will not be required by the ACA to offer health insurance, there are several reasons why small business CEOs should consider it:

  • Competition for talent. Since almost all larger companies offer health insurance benefits, small companies who do not are at a disadvantage when recruiting and retaining talented workers.
  • Affordability. Before 2014, small businesses were at a distinct price disadvantage and paid higher premiums for health insurance than large companies. With the ACA setting “community-based rates,” small businesses will have access to more options and cheaper insurance than they could purchase on their own in the past.
  • Opportunities for tax credits. As of the 2010 tax year, small businesses with less than 26 employees can claim a tax credit of up to 35 percent of premium costs. In 2014 this credit will go up to a maximum of 50 percent and can be used for two years. The Congressional Budget Office estimates that this tax credit will save small businesses a total of $40 billion by 2019.
  • Long-term productivity improvement. Employees of companies that do not offer health insurance tend to be uninsured. Even with the ACA’s 2014 individual mandate, employees may not be able to afford anything but minimal coverage on their own. With the help of their employer, employees can access higher levels of health insurance with lower out-of-pocket expenses, which will encourage the use of preventive services, leading to happier, healthier, and more productive employees and families.

Impact of ACA on Small Businesses

The component of the ACA that impacts small businesses the most is access to health insurance exchanges. Within the next year, small businesses in Texas with fewer than 50 employees will have access to a health insurance exchange either through a federal Small Business Health Options Program (SHOP) or through a Texas-based insurance exchange program offered for individuals. As of this writing, Governor Perry has declared that Texas will not develop an exchange; however, Blue Cross Blue Shield (BCBS) of Texas has announced plans to join with BCBS of Michigan and Well Point, Inc to develop a multi-state exchange that will be available to Texas employers. These health insurance options will be an improvement over what small businesses currently have access to, both in breadth of coverage (all options must offer a standard set of benefits) and in cost.

In the current private insurance market, small businesses are at a disadvantage, paying more per employee for health insurance than larger companies. This disadvantage is particularly high for companies that have an employee or two with pre-existing health conditions or companies with a high percentage of female employees. As of 2010, the ACA prohibited insurance companies from putting lifetime limits on coverage or canceling coverage when employees had high claims. In the past, it was a frequent occurrence for a small company to find itself without coverage or with unaffordable premiums after one employee had an expensive diagnosis such as cancer. By 2014, the ACA will not allow insurance companies to reject individuals because of preexisting conditions, nor can they charge higher premiums based on health histories or gender. These changes will make health insurance accessible and affordable for many small businesses that could not purchase it before. In summary, under the ACA small businesses will get more and pay less. The Congressional Budget Office estimates premiums in the small group market will fall by an estimated four percent while the amount of coverage is expected to increase by three percent.

In addition, the ACA is expected to continue to drive down overall health insurance costs. The state of Massachusetts, which has operated a health insurance exchange very similar to those enacted by ACA for the past six years, has seen health insurance premiums fall by as much as five percent over the last two years. According to the Commonwealth Connector, the agency created by the Massachusetts legislature to interface between the insurance exchange and the public, “The Massachusetts Health Connector’s Commonwealth Care program … will save the state approximately $91 million with no benefit reductions or member co-pay increases.”

Resources for More Information

The best website for small business owners to bookmark for information on health care reform options is This website offers easily accessible information for both individuals seeking health care coverage and for small businesses. It includes a health care insurance finder as well as other small business resources.

Other helpful websites include:


The views expressed are those of the author and not necessarily The University of Texas at Austin.

About The Author

Kristie J. Loescher

Senior Lecturer, McCombs School of Business

Kristie Loescher teaches management, leadership, and business communications. She has a Ph.D. in business administration from Nova Southeastern...


#1 Thank you for this

Thank you for this informative explanation. I have thought many, many times about the main provisions of the Affordable Care Act (ACA) and have wondered how anyone other than those who have pulled themselves up by their bootstraps and expect all others to do the same, nothwithstanding adversities including serious illnesses could be so opposed to the ACA. Do they object to instituting abolishment of the preexisting conditions provisions that have hit certain persons very hard? Do they object to the removal of a cap on total amts. that can be collected under a policy? Do they object to raising from 25 to 26 the age for being insured under one's parents' policy? And the list goes on. I do understand that some persons "know" they will not suffer a serious illness or accident and, thus, believe it is more cost effective for them to go uninsured than pay for health insurance. May they be so fortunate as to be correct! I have had the most sympathy for those criticizing the ACA because of how it affects small businesses. Your article points out the net cost of the ACA for small business owners is lower than many such owners may think it is. Thank you for your enlightenment. I hope your points become widely disseminated.

#2 Thank you for your comment.

Thank you for your comment. I appreciate your support for ACA! Taking a long-term view of the impact on society is a critical perspective for understanding this legisation's potential. Kristie Loescher

#3 Thank you for your comment

Thank you for your comment Anna. I think it comes down to a philosophical question: is access to basic healthcare a right? From a macro standpoint, it is in the best interest of society to maximize the number of its members who can be productive.

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