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Here's one group the GOP health-care bill hurts the most that isn't getting any attention

software programmers
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I had a lot of reasons to fear leaving my job and starting my own consulting business.

My dad tried to start his own business right after I graduated high school. When things didn't work out, it was a blow to his pride he never quite recovered from.

I grew up poor, and way before my dad tried to start his own business, my family was homeless and survived on food stamps and government cheese.

Those experiences meant having a steady paycheck and non-subsidized cheese in the fridge is a big deal to me.

But the biggest concern about starting my own company?

Health insurance.

By the time I started my company, I had been getting consulting clients on the side for about a year, so I was reasonably sure my family wouldn't starve—but health insurance was another matter.

My employer paid 100 percent of my family's health insurance premium, which was incredibly generous, and needed. Though I'm fortunate to have a healthy family, my youngest daughter has a history of seizures, and my son is, well, a son. He has an affinity for sharp tools and anything he can ride, flip, or do a "180" on. We've had multiple rounds of playground-related stitches, and a reattached fingertip after one incident with the neighbor's bushes and electric garden shears.

The challenge of replacing our health insurance was further complicated by being a one-income household. My wife had spent the prior 12 years as a stay-at-home parent, and I was the sole income earner and benefits provider. If I was going to start my company, we needed an alternate plan for health insurance.

For us to make the leap into entrepreneurship, my wife would have to reenter the workforce. Fortunately, the owner of our local startup incubator hired my wife as the facility's first community manager. Her new job meant we now had health insurance, which allowed me to become a full-time entrepreneur.

Other would-be entrepreneurs aren't as lucky as we were.

"Health insurance as a barrier to entrepreneurship is a subject that comes up on a regular basis in the startup community both my wife and I are now a part of."

Research conducted by the Kauffman-RAND Institute for Entrepreneurship & Public Policy in 2010, prior to the implementation of the Affordable Care Act (ACA), showed high healthcare costs created "entrepreneurship lock," a phenomenon where employees can't afford to start their own company because they would lose employer-provided health insurance.

Health insurance as a barrier to entrepreneurship is a subject that comes up on a regular basis in the startup community both my wife and I are now a part of.

Unfortunately, the impact of the repeal on new entrepreneurs hasn't come up at all in the debate about the Republican replacement for the ACA.

Granted, the ACA didn't make health insurance very affordable for most new entrepreneurs, but the elimination of preexisting conditions did free some would-be entrepreneurs to leave employer-provided health insurance with the knowledge they at least had access to healthcare, even if it still wasn't cheap.

A recent survey by consulting firm Thumbtack on small business sentiment in the United States found that access to health insurance under the ACA gave many new entrepreneurs the confidence to start a business, knowing a preexisting condition wouldn't prevent them from purchasing their own policy once they left their employer plan.

Repealing or reforming the ACA should be an opportunity to better address how the high cost of health insurance can prevent aspiring entrepreneurs from starting their own company. Health-care reform should take the accomplishments of the ACA further and make health care accessible and affordable for the entrepreneurs and small business owners Republicans so often tout as job creators.

That's not happening.

In the Republican rush to get a bill passed, the impact of health-care policy on entrepreneurship isn't even part of the discussion.

Most economists and policy analysts predict the Republican bill will drive the cost of health insurance up. When coupled with the disappearing ACA subsidies, the result will be new entrepreneurs who can't afford to cover themselves or their families while their business gets off the ground.

And if you're an entrepreneur who eventually succeeds and can later reenter the health insurance market, you can expect to be penalized by the "continuous coverage" requirement that replaces the existing individual mandate.

In 2014 (the most recent year data was available) there were 452,835 new companies started in the United States.

That's a 40-year low—and the continuation of a decades-long trend of decreasing entrepreneurship. The Kauffman-RAND research shows that trend may have something to do with the equally long trend of skyrocketing health-care costs.

Paul Ryan has made a legislative career out of talking a lot about the challenges faced by entrepreneurs. In the case of health care, he needs to realize that the story is more complicated than just "Small business owners hate Obamacare."

Rather than passing a bill for the sake of saying he repealed the ACA, Ryan should slow the process down, reach out to new entrepreneurs, and craft legislation that encourages entrepreneurship and eliminates the need to choose between their health insurance and starting a new business.

Commentary by Dustin McKissen, the founder and CEO of McKissen + Company, a strategy, marketing, and public relations firm based in St. Charles, Missouri. He was named one of LinkedIn's "Top Voices" in 2015 and 2016. . He holds a Bachelors degree in Public Policy, and a Masters degree in Public Administration and is currently pursuing a PhD in Organizational and Industrial Psychology. Follow him on Twitter @DMcKissen.

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