In a March 23, 2015, press release, the National Federation of Independent Business (NFIB) noted that the Patient Protection and Affordable Care Act (PPACA) turned five years and added, "(W)hile the administration is commemorating the occasion, there is not much for small business to celebrate."

"Premiums are higher, and choices are fewer," said Dan Danner, CEO and president of the NFIB. "The cost of insurance has been the top concern for small business owners for two decades, and the Affordable Care Act has failed entirely to address that problem."

The NFIB predicted these problems earlier in a report on the PPACA, which noted that, "The Patient Protection and Affordable Care Act (PPACA) creates numerous problems for small businesses – higher costs, greater administrative burdens, fewer healthcare choices, and competitive disadvantages vis-a-vis big business."

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