Mid-sized U.S. businesses are definitely still looking for the silver lining in the Patient Protection and Affordable Care Act.

Paying for employee health insurance, and managing the effects on their business of the act, rank as their top two concerns in an ADP study of more than 1,000 businesses with between 50 and 999 employees.

Unlike small businesses, these economic engines can't avoid the requirements of the act. And unlike their larger brethren, many of them have neither the resources nor the political clout to easily adapt to the changes rolling through the health care landscape.

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