Across America, small business owners are sounding the alarm as Congress lets the Affordable Care Act’s enhanced premium tax credits (EPTCs) edge toward expiration with no alternative in place — a change that could raise health costs for millions and force many small business owners to make difficult choices about their operations, their employees’ health insurance, and even their own coverage. 

According to a new survey by the Main Street Alliance (MSA), more than one in four small business owners (27%) rely on EPTCs and another 10% rely on Medicaid to stay insured. If Congress lets the EPTCs expire or cuts Medicaid, the effects would be immediate and severe: 

• More than 30% of small-biz owners say they or a family member would lose health coverage, and 

• More than 31% of small-biz owners say they would be forced to cut spending on business or household essentials. 

For small business owners, affordable health care isn’t just a family issue — it’s a business survival issue. Many operate on tight margins, and when premiums rise, it doesn’t just threaten coverage — it affects hiring, investment, wages, and the ability to keep their doors open. 

Susan Bauer, co-owner of Rock Paper Scissors, a stationery and gift shop in North Hollywood, CA, says the ACA premium tax credits are critical to keeping her team insured and healthy: 

My small staff purchases healthcare through Covered California. They would not be able to afford premiums without the PTCs. If overall premiums rise because of this, my husband, my business partner, and I would have to reassess our coverage to be able to afford it. 

Cheryl Wieseler, owner of Cluck Ewe Farm and Bakery in Decorah, IA, knows this firsthand: 

We honestly aren’t sure what we’re going to do. We’re both covered under the ACA, and we may end up without insurance, because our estimated premiums would almost eat up all my profits — especially when combined with increasing costs from tariffs, inflation, and everything else affecting my business. What frustrates me most is hearing legislators talk about how much they care about small businesses. They really don’t, because the policies they’re voting for hurt us. We’re not billionaires, so it seems we’re not the ones they’re working for. 

Despite the daily challenges small businesses face, Washington’s priorities continue to tilt toward the powerful. When the GOP pushed the OBBBA (One Big “Ugly” Bill Act) through Congress — a bill packed with tax breaks for big corporations and the wealthy — small businesses were merely an afterthought. One crucial part of tax policy that truly matters to them — preventing the expiration of the ACA enhanced premium tax credits — remains unaddressed. 

Mike Ohlinger, founder of OhmCo, a carwash marketing agency in Neenah, WI, points out the contrast in tax policies and incentives: 

The OBBBA does offer tax breaks and incentives, but outside of a few benefits toward large equipment purchases in our industry, neither our customers — who are largely small mom-and-pop operators — nor we will see any benefit. We’re not in a position to take advantage of being able to fully depreciate the purchase of a private jet. In fact, combined with the economic instability caused by back-and-forth tariff threats, we’re facing the potential of our first year without growth. 

More than 70% of the tax breaks will go to the wealthiest fifth of households, while the middle class gets just 10%. Here in Wisconsin, the top 1% of earners will walk away with average breaks close to $70,000. For families earning under $80,000 a year, the break is less than $1,600. 

These very immediate pressures on small businesses if Congress does not act to extend the enhanced tax credits help to explain why research funded by the Commonwealth Fund showed that 340,000 jobs would be lost in 2026 alone if the ACA enhanced premium tax credits are allowed to expire.

Whether it’s a marketing agency in Wisconsin, a farm in northeast Iowa, or a stationery store in sunny California, small businesses are feeling the same pressure: rising costs, inequitable tax policies, and the looming threat of increasing cost of health care or losing health coverage altogether.

Unlike the Congressional Budget Office’s long-term projections, small business owners do not have to wait 10 years to see the consequences of Washington’s choices — they’re feeling them right now. The consequences of these policy choices will raise health care and overall costs, while making it harder for small businesses to invest, innovate, and flourish.

From October 29 to November 5, one of CHN’s newest member – the Economic Security Project is hosting the Stop the Healthcare Heist National Week of Action. Join us and many more partners to take action. You can find an event near you here.