For Main Street, health-care costs overall remain a key issue as small companies strive to grow their businesses and hire more workers after the deep recession. "This is not how we preferred it to be done," said Molly Day, a spokeswoman for the National Small Business Association. "But we do have key reforms that need to be made more workable for small firms."
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For example, Day cited the health-insurance tax. Known as HIT, the tax raises the cost of small-business health-insurance premiums. HIT "will be passed on more to small businesses as they are fully insured, versus large firms that are self-insured," Day said.
The employer mandate is another cause for concern among members, Day said, with 1 in 4 small businesses saying they're "purposefully not growing" because of the mandate.
Supporters of the Affordable Care Act say the measure is long overdue, and that employees with health insurance can help boost employee retention and recruitment efforts.
But other Main Street groups disagree. "I don't know that it's adding to confusion, but potentially to frustration," Day said. "I don't know that small-business owners are in a better position than they were five years ago with our health-care system."