Over the past few weeks the Obama Administration has placed the topic of health care reform front and center on the national agenda. The move has sparked fresh debate, concern, and anxiety among politicians, consumers, business owners big and small, as well as health industry experts and representatives.

Most agree that something must be done to change a system where approximately 45 million people across the US are uninsured and that oversight should be extended to regulate a health insurance industry accused of using deliberate and questionable tactics to maximize profits, such as raising premiums, co-pays and deductibles, refusing coverage or charging exorbitant rates to people with pre-existing conditions, and even retroactively denying coverage to people with established policies.

But exactly what will be done in the end is still very much up in the air, and this has been a subject of much concern among small business owners in particular.

It is estimated that about half of those who are uninsured are people who are either self-employed or who work for small businesses. While most big companies still provide health benefits, an astronomical rise in insurance premiums over the last decade has help to create a situation where many small businesses can no longer afford to cover their employees.

There are really three key issues in health care reform of particular concern to small businesses, namely: employer mandates, the creation of a government-run, public insurance plan, and changes to the tax code.

With employer mandates the government would require businesses to either provide health insurance to their employees or pay a fee to the federal government. This may be too much of a financial burden for very small businesses- especially in the present economy. The establishment of a public health plan could provide much needed competition to private insurers and reduce the cost of health insurance. But some fear that this will drive private insurers out of business. Finally, various changes to the tax code have been proposed, of mention are several tax increases, such as taxing some employer-provided coverage, and small business tax credits to help offset the costs of providing insurance.

Whatever the actual outcome of the health care reform bill, the relationship and involvement of small businesses to health benefits is likely to change… for better or for worse.

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