Forget the economy. Most small businesses say the Patient Protection and Affordable Care Act is their biggest concern.

The U.S. Chamber of Commerce's latest quarterly small-business survey found that 77 percent of small businesses say health reform will make coverage for their employees more expensive, and 71 percent say the law makes it harder for them to hire more employees.

Just 4 percent think reform will make health coverage more affordable, while 20 percent don't think it will have much impact.

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