Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

HSR Citation Abstract

Search | Search by Center | Search by Source | Keywords in Title

Exploring Early Small Business Decisions under the Affordable Care Act

Kullgren JT, Cliff EQ, So J, Saksewski S, Peterson T, Singh S. Exploring Early Small Business Decisions under the Affordable Care Act. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 26; Boston, MA.

Related HSR&D Project(s)


Research Objective: Despite widespread debate about how small businesses are being affected by new opportunities and challenges under the Affordable Care Act (ACA), there are few data on how small firms are thinking about and responding to these changes. We conducted a qualitative study of frontline small business decision makers to examine their recent health care decisions and better understand how the ACA is impacting their current and future plans. Study Design: We conducted semi-structured telephone interviews with health care decision makers from businesses with between 3 and 99 employees in the 6-county region surrounding Detroit, Michigan. The sample frame was provided by a national firm that aggregates publicly available business contact information. From this frame, we generated a random sample stratified by whether businesses had 3 to 49 or 50 to 99 employees. We contacted sampled businesses by telephone and invited the individual who makes health insurance and health care programming decisions for the business to participate in a 30-minute interview, for which we provided a $50 gift card. Interviews covered reasons for offering or not offering health insurance, use of brokers, and attitudes towards and responses to the ACA. We conducted interviews between July 2014 and February 2015, and stopped when we reached thematic saturation. All interviews were audio-recorded and transcribed. Team members met to discuss the themes, refine them, and achieve consensus on codes and definitions. Two team members used the final codebook to double-code all transcripts. Population Studied: 49 health care decision makers (24 from firms with 3 to 49 employees and 25 from firms with 50 to 99 employees) for businesses in metropolitan Detroit, Michigan. Principal Findings: Most businesses offered health insurance, typically to recruit or retain employees, or because of tradition or a high valuation of health. No businesses reported offering coverage because of the ACA. Nearly all firms that offered coverage used a broker, who they usually trusted to provide options and information about both the small group insurance market and ACA compliance. Most firms that offered insurance planned to continue offering coverage into the future, though several had recently moved to a defined contribution. Among firms that did not offer coverage, none were planning to start offering coverage. The majority of respondents were at least somewhat familiar with the ACA. Most had neutral views of the ACA, but negative views were more common than positive views. Although the ACA had led some firms to change hiring practices, the distribution of workers' hours, or insurance benefits, most firms reported no changes to their business plans or insurance offerings due to the ACA. Conclusion: Health care decision makers from small businesses in a large metropolitan area had mostly neutral views of the ACA and reported few early changes to their business practices and insurance offerings due to the ACA. Brokers may be playing vital roles in helping small businesses navigate health insurance options and new regulations. Implications for Policy or Practice: Though some small businesses initially responded to the ACA with changes to their health insurance and workforces, many have not yet undertaken such changes. Funding Sources: Detroit Community-Academic Urban Research Center Word Count: 497

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.