Democrats Are Fighting for Health Care for Small Business Owners and Their Employees
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- Congressional materials
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- Cost Of Republican Aca Cuts
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- Cost Of Republican Aca Cuts
Summary
A Democratic messaging document titled Democrats Are Fighting for Health Care for Small Business Owners and Their Employees, citing new analysis from Small Business and Entrepreneurship Committee Democrats. It states that more than 10 million small business owners and employees rely on enhanced ACA premium tax credits, including 4.2 million small business owners, and that the credits will expire on December 31 because Republicans blocked an extension. It states that premiums for that group will rise an average of 114%, or $1,016, in 2026, and that 447,000 small business owners will lose eligibility. The document includes quoted statements from small business owners and a state-by-state table of small business owners receiving the credits in 2025, totaling 4,236,694, with sourced endnotes.
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“Democrats Are Fighting for Health Care for Small Business Owners and Their Employees.”
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Democrats Are Fighting for Health Care for Small Business Owners and Their Employees
Democrats are fighting every single day to protect access to affordable health care for small businesses.
This year, 22 million Americans, including over 10 million small business owners and their employees,
received enhanced premium tax credits to help afford health insurance through the Affordable Care Act
(ACA). Because Republicans have blocked Democrats’ efforts to extend the credits, they will expire on
December 31, doubling or tripling the cost of next year’s premiums compared to 2025. The loss of these
tax credits follows Republicans’ historic Medicaid cuts this summer, which will slash Medicaid coverage
for 8 million small business owners and workers. Small businesses and families are already
struggling to survive in Trump’s economy. While Republicans are fighting for CEO billionaires,
Democrats are fighting to protect access to affordable health care for all.
Background: Health insurance is essential for American families and small businesses. Everyone
should have access to affordable health care—not just the wealthy few.
• Democrats expanded the ACA’s premium tax credits in 2021, allowing more small business
owners and their employees access to affordable health insurance than ever before.
• According to new analysis from Small Business and Entrepreneurship Committee Democrats,
more than 10 million small business owners and their employees enrolled in ACA health care
plans rely on enhanced premium tax credits to afford health insurance.
o 4.2 million small business owners receive the credits.
o Nearly 60,000 small business owners in Massachusetts rely on the credits to afford
health insurance. See page 3 for full state-level data.
o Nearly 6 million small business employees receive the credits.
Because Republicans have blocked the extension of enhanced premium tax credits, small
businesses will be hit with higher health care costs or lose coverage altogether.
The over 10 million small business owners and their employees who get coverage through ACA plans
will see their annual premiums increase an average of 114%, or $1,016, in 2026. i
• 447,000 small business owners with annual incomes above $62,600 for an individual or
$128,600 for a family of four (400% of the federal poverty level) will no longer be eligible for
premium tax credits. ii
• 3.8 million small business owners will face reduced tax credits.
• Several Marketplace plans have increased premium costs because of the uncertainty created by
Trump’s tariff policies. iii
An additional 630,000 small business owners and over 7.5 million small business employees who
rely on Medicaid will face barriers to coverage. iv
1
Personal Stories:
Chris Edmundson, Colorado small business owner on Medicaid:
“Medicaid is the only way for student physical therapists to access healthcare coverage while in school.
Without this coverage, some of our employees would likely have been discouraged from pursuing the
type of advanced degree necessary to work in our business. We are already confronted with a
considerable provider shortage in our profession. Reducing Medicaid’s accessibility would only
exacerbate our provider shortage. We urge federal policymakers to maintain Medicaid funding so that
small businesses like mine have access to the workforce we need to serve our communities.”
Melody A., Massachusetts small business owner on ACA enhanced premium tax credits:
“I have a small woman-owned business in Western Massachusetts… I am also a veteran from the Army
Guard of Massachusetts. I have a small workforce and when I was told we all had to have health
insurance, the Health Connector was my lifeline. v The Health Connector and [premium] tax credits
made this affordable and possible not just for myself, but my workers. Some of my workers have
families… The Health Connector was a lifeline for me because this past year I had a cerebral stroke and
thank goodness I had the coverage to cover this life-threatening episode and did not have to worry about
the bills. I just needed to focus on getting well.”
Janna Rodriguez, New York small business owner on Medicaid:
“If Medicaid access is reduced, we are accelerating that [health care] crisis and making it nearly
impossible for small child care businesses like mine to maintain quality and consistency. At its core, this
is about equity and sustainability. Childcare is essential infrastructure—economic, educational, and
social. If we are serious about stabilizing this sector, we must protect Medicaid and treat health care
access as a baseline support for our workforce. As a business owner and community advocate, I’m
dedicated to creating a stable, respectful, and nurturing workplace for my team. But without Medicaid, I
have no alternative to offer them—and that puts the entire foundation of our care model at risk.”
Chrysa Ostenzo, Wisconsin small business owner on ACA enhanced premium tax credits:
“As small business owners, we had been used to spending around 20–25% of our income, over $30,000
per year, on health care. The American Rescue Plan reduced that percentage to 8.5%, allowing us to
finally get some relief. Some of my employees were able to afford insurance for the first time in years. It
is critical that Congress extend, indefinitely, the 8.5% provision so that people don’t have to wonder
from year to year whether they will have health care or not.”
2
State # of Small Business State # of Small Business
Owners Receiving Owners Receiving
Enhanced Premium Enhanced Premium
Tax Credits, 2025 Tax Credits, 2025
Florida 872,872 New York 35,033
Texas 672,051 Kansas 34,425
California 406,812 Connecticut 34,358
Georgia 266,571 Iowa 29,495
North Carolina 142,800 Arkansas 27,945
Tennessee 110,205 Nebraska 27,679
Pennsylvania 98,236 Oregon 25,025
New Jersey 92,097 Minnesota 22,713
Michigan 90,139 Nevada 21,440
South Carolina 89,376 Idaho 21,165
Illinois 86,756 Kentucky 19,276
Ohio 84,675 Montana 15,416
Alabama 82,450 New Hampshire 13,534
Missouri 75,055 New Mexico 13,067
Arizona 63,675 West Virginia 12,408
Virginia 60,291 Maine 12,320
Massachusetts 56,952 South Dakota 11,250
Louisiana 56,400 North Dakota 8,798
Wisconsin 54,697 Wyoming 8,190
Indiana 54,112 Delaware 8,080
Oklahoma 51,156 Vermont 7,917
Washington 50,932 Hawaii 7,533
Mississippi 48,872 Rhode Island 6,450
Utah 46,116 Alaska 4,800
Colorado 44,928 District of Columbia 1,360
Maryland 39,600 Total 4,236,694
States in red were won by President Trump in the 2024 Presidential election, and in blue were won by Vice President Harris.
Calculations informed by projected state enrollment from the Center on Budget and Policy Priorities (CBPP) for 2025, and
2023 Treasury data. vi
3
i
Justin Lo et al., ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium
Tax Credits Expire, KFF (Sep. 30, 2025), https://www.kff.org/affordable-care-act/aca-marketplace-premium-payments-
would-more-than-double-on-average-next-year-if-enhanced-premium-tax-credits-expire/.
ii
Affordable Care Act Marketplace Coverage for the Self-Employed and Small Business Owners, U.S. Dep’t of the Treasury
(Sep. 20, 2024), https://home.treasury.gov/system/files/131/ACA-Mkt-Coverage-Self-Employed-Small-Business-Owners-
09232024.pdf.
iii
Matt McGough et al., Tariffs Are Driving up Premiums for Small Businesses, KFF (Aug. 25, 2025),
https://www.kff.org/health-costs/tariffs-are-driving-up-premiums-for-small-businesses/.
iv
Joan Alker & David Chase, Medicaid is a Critical Insurer for Small Business, Center for Children and Families and a
Research Professor at the Georgetown McCourt School of Public Policy (June 26, 2025),
https://ccf.georgetown.edu/2025/06/26/medicaid-is-a-critical-insurer-for-small-business/.
v
The Health Connector serves as Massachusetts’ ACA Marketplace.
vi
Gideon Lukens, Research Note: 5 Million Small Business Owners and Self-Employed Workers Likely Enrolled in ACA
Marketplace in 2025, Ctr. on Budget and Pol’y Priorities (June 12, 2025), https://www.cbpp.org/research/health/5-million-
small-business-owners-and-self-employed-workers-likely-enrolled-in-aca; see also Affordable Care Act Marketplace
Coverage for the Self-Employed and Small Business Owners in 2023, U.S. Dep’t of the Treasury (Jan. 14, 2025),
https://home.treasury.gov/system/files/131/ACA-Mkt-Coverage-Self-Employed-Small-Business-Owners-2023-01142025.pdf.
4
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