This report compiles findings from focus groups and roundtable discussions with rural small business owners and other small business stakeholders in four states, as well as the results of a national poll of rural small business owners. The report also features recommendations for policymakers and service providers to increase opportunities for rural entrepreneurs.

Health insurance exchanges are the most important component of healthcare reform for small businesses. These marketplaces will allow small businesses and individuals to band together to purchase insurance, which will lower their healthcare costs and allow more of them and their employees to get quality healthcare coverage. 

In March 2011, Small Business Majority and Pacific Community Ventures (PCV) released the results of a survey, commissioned by PCV, of 804 California small business owners with fewer than 20 employees on key provisions of the Affordable Care Act. It found that small business owners who currently don’t offer health insurance, along with those who do, are more likely to provide or continue to provide coverage because of the healthcare tax credits and state insurance exchange.

Executive Summary

More than any other sector of the economy, small business suffers from our broken healthcare system. From spiraling premium costs to inadequate access to quality healthcare for themselves and their employees, small business owners have seen their prospects for growth diminished and their profits slashed by today's patchwork of inefficient healthcare options.

When the Affordable Care Act was signed into law in 2010, it delivered sweeping reform to the nation’s healthcare system. A significant feature of the law is an expansion of Medicaid to cover a larger number of low-income individuals. In June 2012, the Supreme Court ruled it was up to each state to decide whether to expand eligibility for Medicaid. Medicaid expansion gives every state the opportunity to take advantage of federal funding that will support jobs and stimulate economic growth while expanding health coverage.

When the Affordable Care Act was signed into law in 2010, it delivered sweeping reform to the nation’s healthcare system. A significant feature of the law is an expansion of Medicaid to cover a larger number of low-income individuals. In June 2012, the Supreme Court ruled it was up to each state to decide whether to expand eligibility for Medicaid. The Medicaid expansion gives every state the opportunity to take advantage of federal funding that will support jobs and stimulate economic growth throughout the state while expanding health coverage for its residents.

On June 12, 2012, Small Business Majority and Kaiser Permanente released opinion polling that provides new insight into what small business owners in California and Oregon want out of state health insurance exchanges, which are being created under the Affordable Care Act. The polling found interest in a small business exchange is high, along with specific features in the exchange, including allowing employees to choose among multiple carriers and ensuring prevention and wellness programs are available. The survey also found awareness of the small business tax credits is low.