The Affordable Care Act’s Impact on Small Business.

Issue: Small-business owners have seen significant gains in health care coverage for themselves and their employees thanks to the Affordable Care Act. Though efforts to repeal the law failed in 2017, the current administration continues to take steps that undermine the law’s progress. In recent months, new rules have been announced that allow more groups to establish association health plans and extend the length of short-term health insurance plans. These changes are likely to impact the stability of the marketplaces and coverage rates for the small-business community.

Goal: Examine the Affordable Care Act’s impact on small businesses, solo entrepreneurs, and small-business employees.

Methods: Analysis of ACA small-business enrollment data from established sources, including federal agencies and nonpartisan health care research foundations, supplemented by analysis of U.S. Census data.

Findings and Conclusions: Because of the creation of the individual marketplaces and the expansion of Medicaid, more entrepreneurs and small-business employees have health coverage than before the ACA was implemented. Indeed, the uninsured rate for small-business employees fell by almost 10 percentage points post-ACA. The ACA also has helped stabilize health costs for many small businesses that provide coverage, with the rate of small-business premium increases falling by half following implementation of the law.