Opinion: It’s time to listen to our small businesses — and to save the Affordable Care Act

The State
October 8, 2020


Twenty years ago the South Carolina Small Business Chamber of Commerce held eight forums across the state to hear what small business owners needed to help them thrive and grow.

One issue that topped the list of problems was the cost of health care.

The 1990s had seen health insurance premiums for small groups double every year. It was an unsustainable escalation that was driving small businesses to stop offering the benefit to their employees.

And these premium increases continued through the 2000s.

“I want to get out of the health insurance business,” was the common refrain from small business owners. They were tired not only of the rising premiums, but also the extensive administration required to offer health care benefits.


But in 2010 we saw the start of the Affordable Care Act, which primarily addressed the health care cost issue by making sure that every American had some type of insurance — private or public.

No longer would the cost of the uncompensated care for the uninsured be passed on to those with insurance, which had been a significant driver of rising premiums.

And for the next six years the giant annual premium increases were tamed.

But then a new Congress and President Donald Trump took actions to weaken the Affordable Care Act, and the premium costs began surging again.

So it is no surprise that in a recent poll by Small Business for America’s Future, 71% of the respondents said that affordable health care was a top policy priority — again.


Small businesses are willing to try anything to solve the problem; indeed in the survey 67% of the respondents said that the Affordable Care Act should be strengthened. And the one thing that most small business owners certainly don’t want is for the Affordable Care Act to be eliminated.

Yet that is what is about to happen in the U.S. Supreme Court.

The Court is set to hear arguments in November on whether the Affordable Care Act is unconstitutional.

President Trump and most of the Republican members of Congress have long wanted to get rid of the Affordable Care Act. And with the recent death of Justice Ruth Bader Ginsburg — and the pending arrival of a new conservative justice on the bench — the Supreme Court is very likely to support a lower court ruling that the Affordable Care Act is unconstitutional.

The result will be a victory for Trump and the Republicans, but it will be a crisis for the nation.


In all more than 20 million people will lose their private or public health insurance — and hundreds of thousands of them live in South Carolina.

The 130 million Americans with preexisting conditions and private health insurance face these stark possibilities:

▪ Their policies won’t be renewed.

▪ Their preexisting conditions won’t be covered.

▪ Their insurance premiums will skyrocket in cost.

And we can now add the 10% of Americans, including President Trump, who have contracted COVID-19. Even if they are asymptomatic, they will now be considered to have a preexisting condition.


Small business owners will once again see yearly double-digit premium increases because one of their employees has a preexisting condition — and because of the dramatic increase in the number of uninsured individuals.

In addition Trump’s recent executive order on preexisting conditions will have no power over what private insurance companies do.

Trump has claimed for five years that he has a better health care plan than the Affordable Care Act. But this plan does not exist, and the reality is that only Congress can fix what the Supreme Court is about to break.

With millions having lost their employer-based health insurance in an ongoing pandemic, the Supreme Court is about to make things worse by taking away the affordable health insurance offered by the Affordable Care Act.

The next Congress will need to quickly correct any constitutionality issues in the Affordable Care Act. Then it must follow the opinion of small business owners, and strengthen the Affordable Care Act.

Frank Knapp is CEO of the South Carolina Small Business Chamber of Commerce.


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