For a myopic view of Obamacare's effect on small business, one can look at its results in Louisville, Kentucky. The state saw one of the biggest drops in uninsured individuals under the Affordable Care Act, from 20.4 percent in 2013 to 7.8 percent in 2016, largely in part to the state's expansion of Medicaid. The state operated its own Obamacare marketplace for two years before moving to the federal exchange in 2017, where today only three insurance companies offer coverage on exchange.
Of late, Louisville has become a flashpoint for the GOP to tout its plans to repeal and replace, with visits from both President Donald Trump and Vice President Mike Pence in recent months to talk about why the ACA isn't working in the state, or elsewhere. The GOP's mantra after winning a House vote to repeal and replace key provisions of the law: Obamacare is failing, insurance companies are pulling out of exchanges, and small-business owners are being squeezed by rising premiums.
The National Federation of Independent Business' "Problems and Priorities" survey for 2016 showed the cost of health insurance remained the top issue for small companies, as it has been over the past 30 years. The conservative lobbying group found insurance premiums have risen 56 percent in the last decade for small firms, and that only 29 percent of small companies offered health insurance in 2016, down from 42 percent in 2004.