Our Research: Healthcare
Small Business Majority uses extensive scientific and opinion research to provide small business owners, advocates, policymakers and others with the information and tools they need to navigate through complex healthcare-related issues.
The U.S. Supreme Court’s 2022 decision to overturn Roe v. Wade has reshaped reproductive healthcare access—and small business owners are feeling the impact. New research from Small Business Majority shows that entrepreneurs overwhelmingly believe access to reproductive healthcare is critical for workforce participation, economic stability and long-term business success. While many business owners report uncertainty or limited direct impact so far, more say the decision has hurt their businesses than helped—affecting profitability, hiring and workforce stability. Women entrepreneurs, in particular, express deep concern, with many warning that abortion restrictions force women to choose between their careers and reproductive freedom. As access continues to narrow in many states, small business owners across the country are increasingly worried about the long-term economic consequences for their employees, their communities and their bottom lines.
On November 13, 2025, Small Business Majority released a research report examining the challenges small businesses face from rising healthcare premiums and increased immigration enforcement. The survey found that two-thirds of small business owners view higher healthcare costs as a significant financial burden and strongly support extending the Affordable Care Act’s enhanced premium tax credits. Entrepreneurs also reported negative effects from immigration enforcement and expressed strong support for modernizing the legal immigration system and creating pathways to citizenship for qualifying undocumented immigrants.
As Congress and the administration consider 2025 policies, small business owners are raising concerns about rising tariffs, slowing growth, immigration policy impacts, and threats to healthcare from Medicaid cuts and ACA changes. Many are responding by raising prices or pausing expansion. They also oppose increasing the federal deficit to fund tax cuts for the wealthy and large corporations.
This issue brief, developed in partnership by Small Business Majority and the Georgetown University Center for Children and Families, examines the prevalence of Medicaid as a source of insurance for small business owners, employees, and their family members using 2024 data from the Census Bureau’s Current Population Survey Annual Social and Economic Supplement (CPS ASEC). Small businesses are defined as those with under 100 employees. Our analysis of 2019 data prior to the pandemic revealed similar shares.
Since the U.S. Supreme Court overturned Roe v. Wade in 2022, reproductive healthcare access has changed dramatically across the country. These changes aren’t just affecting individuals—they’re also impacting small businesses. To develop a deeper understanding of how access to reproductive health services impacts entrepreneurs, Small Business Majority held three focus group discussions in January 2025 with 16 diverse small business owners from across nine states.
Small businesses are rebounding from issues stemming from the pandemic, but rising healthcare costs are hurting their bottom lines and limiting their growth. New opinion polling reveals that small business owners strongly support bipartisan policy solutions that lower costs by setting price caps, increasing transparency and promoting competition in the healthcare industry.
One year after the U.S. Supreme Court’s decision to overturn Roe v. Wade, Small Business Majority conducted an opinion poll of women small business owners to understand the importance of reproductive rights to their economic well-being and to the entire small business ecosystem. They support improved and expanded access to reproductive healthcare, including birth control and abortion.
As entrepreneurs continue to navigate business and economic challenges stemming from pandemic, Small Business Majority surveyed small business owners and operators in Colorado to assess business conditions and the rising costs of healthcare.
California lawmakers are weighing a proposal to require proof of COVID-19 vaccination or a negative test for customers at consumer-facing businesses and to similarly require employers to mandate vaccinations or negative COVID-19 tests for employees. New opinion polling from Small Business Majority reveals that small businesses in California are supportive of proposals to mandate vaccinations and testing at places of business to help ensure local economies can operate safely, amid setbacks from the current surge in COVID-19 cases.
Historically, small businesses have struggled to access health coverage due to the cost, representing a disproportionate number of the working uninsured prior to the implementation of the Affordable Care Act (ACA). And when they have been able to afford it, small businesses often paid more than their larger counterparts. These barriers are now being exacerbated by the COVID-19 pandemic, as small businesses are forced to lay off or furlough employees and make cuts to benefits in order to survive the ongoing economic crisis. A recent national survey of small business owners sheds light on these ongoing issues facing small businesses, as well as their views on policy solutions that could help them access and afford coverage into the future.
