Voice of Main Street: Small businesses support healthcare premium relief, immigration reform

As Congress and the Trump administration continue to enact wide-ranging policy changes, it’s important that they take into account the views and needs of entrepreneurs. It’s particularly critical that they recognize small business owners are already struggling with rising healthcare premiums and take action to immediately prevent further price hikes before rates skyrocket yet again. 

About half of all Affordable Care Act (ACA) marketplace enrollees are small business owners, employees, or self-employed individuals, and small business owners are three times more likely to rely on the Marketplace for coverage than other enrollees. Amid the COVID-19 pandemic, Congress created the ACA’s enhanced premium tax credits (EPTCs) to make coverage more affordable and accessible. These credits are crucial to the small business community; they’ve lowered premium costs for 82% of small business owners and self-employed entrepreneurs enrolled in the Marketplace. Congress later extended the EPTCs through 2025, and they are now set to expire if Congress chooses not to act.  

If the tax credits are not extended, it is estimated that the amount subsidized enrollees pay for their premiums will increase by 114% on average in 2026. The survey reveals that two-thirds of small business owners see increasing healthcare premiums as at least a moderate financial burden on their business. Small business owners strongly support an extension of the EPTCs to avoid premiums skyrocketing even higher. 

These are among the latest findings in Small Business Majority’s Voice of Main Street opinion poll series, a quarterly look at the challenges and opportunities that entrepreneurs in our network are facing when it comes to a range of issues. In addition to shedding light on healthcare affordability, the report shows how increased federal immigration enforcement has harmed small businesses. Entrepreneurs instead strongly support immigration reform that would modernize the legal immigration system and create pathways to legal status or citizenship for qualifying undocumented immigrants.
With small business optimism stagnating and key small business indicators on the decline as a result of federal policy decisions, lawmakers in Washington must act soon to restore confidence by offering significant benefits to America’s Main Street innovators and job creators.

Key findings:

• Only 42% of small business owners are optimistic about their business prospects over the next six months as 66% report that business expenses increased over the past three months.
• Over the past three months, revenues decreased for 45% of entrepreneurs and stayed about the same for 41% of small businesses.
• Employee headcount dropped (24%) for far more small firms than it has increased (3%). This declining headcount is a nine percentage-point increase from August’s survey.
• Two-thirds of small business owners say that increasing healthcare premiums places at least a moderate financial burden on their business, with 47% calling it a major financial burden.
• Sixty-eight percent of entrepreneurs support extending the enhanced premium tax credits for ACA health plans, with only 9% opposing their extension.

• Nearly half (47%) of small business owners say that increased immigration enforcement has had a negative impact on their business.
• Small businesses strongly support (89%) immigration reform that modernizes the legal immigration system to reduce backlogs and makes it easier for qualified workers to come into the U.S. legally. The vast majority (87%) also support providing a pathway to citizenship for “Dreamers,” undocumented immigrants who were brought to the U.S. as children.
• Due to recent changes to tariffs, half of small business owners have increased the price of certain materials or products, while 29% have delayed importing materials or goods and 22% have delayed business growth expansion plans.