David Weeks, who runs WKS, a small engineering firm in Minneapolis, Minn., says he hopes the health care premiums he pays to cover his 17 workers won't continue to rise. But he laughs, a bit nervously, as soon as he expresses that hope.

"It's probably just wishful thinking on my part," he says. "It's consistently been my largest monthly cost, next to payroll."

Weeks, like many other small employers across the country, worries about the increasing cost of health insurance premiums and whether the Patient Protection and Affordable Care Act will make a difference.

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