As a result of the ACA, small business employees actuallyexperienced a large increase in coverage because many were able toenroll in subsidized individual market or in expanded Medicaidplans.

While the situation could change due to the coronaviruspandemic, which is taking a toll on small businesses, up throughthe end of 2018 the small business health insurance market washealthy through 2018, in spite of fears that the Affordable CareAct would be tough on small businesses.

Instead, according to a report from the Commonwealth Fund, rather thanthe ACA being too burdensome on small-business employers and end upwreaking havoc on the small-group health insurance market, itactually helped to stabilize premiums and made coverage both moreaccessible and more comprehensive—despite White House claims to thecontrary.

Related: Small businesses see wins in expandedAHPs

Of course, the pandemic and new rules that allow unregulatedhealth plans could overset everything, destabilizing the market—asthe ACA did not do.

As of 2016, while the ACA had not reduced the cost of coveragefor small-group insurance, additional data for 2017–2018 shows thatsmall-group employers have not faced fewer coverage options. Infact, although enrollment "diminished steadily," that was due toemployers choosing to self-insure rather than pay premiums andcontinued a trend that had begun before the ACA.

In addition, small business employees actually experienced alarge increase in coverage because many were able to enroll in theACA's subsidized individual market or in expanded Medicaid, withthe trend being most notable among workers at midsized firms (20–49workers). The uninsured rate actually dropped from 30 percent in2012 to 13 percent in 2018.

Premiums have been relatively stable under the ACA, increasingon average about 5 percent annually—just slightly higher than the4.5 percent average in the large-group market. In the 10 yearsprior to the ACA, double-digit increases were common in thesmall-group market.

The report adds, "Another indication of the small-group marketstability is that several hundred insurers continue to compete init because it remains profitable."

It remains to be seen what effect both the coronavirus pandemicand the new regulations from the Trump administration will do tothe small-group market, it adds, with the former possibly leadingto much steeper enrollment declines and premium increases and thelatter allowing small groups to buy coverage outside the regulatedmarket through association health plans. It concludes, "Vigilancewill be required to assess whether these or other destabilizingthreats cause real damage to the small-group market."

Read more: 

• Study: Public option plans could bring premiumsdown
• America will dramatically change the way itprovides health care by 2030
• More insurers returning to ACAmarketplaces