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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Health reform requirements are now the biggest concern for small businesses, having bumped economic uncertainty from the top spot, which it has held for the last two years, according to the survey.

Roughly one-third of small businesses (32 percent) plan to reduce hiring as a result of the health legislation's employer mandate, and 31 percent will cut back hours to reduce the number of full-time employees, the survey found.

Beginning in January, PPACA will require businesses with 50 or more full-time employees to offer their employees health insurance or pay additional taxes. The rule doesn't apply to businesses with fewer than 50 employees.

Additionally, the survey found 79 percent of small businesses believe the economy is on the wrong track.

This is the latest report to examine how small businesses are reacting to reform regulations. A recent survey by eHealth, the parent company of eHealthInsurance, found that though awareness has improved slightly over the past year, most small business owners still don't understand how the law affects them.

The U.S. Chamber of Commerce Small Business Outlook Survey was conducted online from March 14–26 by Harris Interactive among more than 1,300 small business executives.

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