LaRonda Hunter, a business owner in Fort Worth, Tex., views the Affordable Care Act as a literal job killer. Fearful of triggering the law’s employer mandate, which requires businesses with 50 or more workers to offer health insurance or pay penalties, Ms. Hunter has held off on expanding her small chain of hair salons.
She voted for President Trump with the hope that he would quickly make good on his promise to strike down the health care law. On Friday, she watched in despair as the Republicans’ replacement plan unraveled — leaving the law, commonly known as Obamacare, in place “for the foreseeable future,” according to Paul D. Ryan, the House speaker.
“We thought, ‘Thank God,’” Ms. Swenson said of the Affordable Care Act’s continuation. “We’re not young. The car is starting to break down a bit. If we lost this policy, we might not be able to get another.”
But every business is uniquely affected by the complex law, and simply demolishing it without putting new guardrails in place is not, for most, the ideal outcome. Small-business owners overwhelmingly say they want Republican and Democratic leaders to quit their partisan bickering, acknowledge that the country’s health care economics are fundamentally broken, and work together on fixing the problem.
“The cost of health care had a significant impact on our profitability last year,” said Tom McManus, 46, the chief executive of KegWorks, a bar supplies retailer in Buffalo. “Obamacare made it worse, but I didn’t see anything in the new bill that would have made it any better. They need to focus on the real health care problem: cost.”
For Thomas E. Secor, who runs the small manufacturing business Durable Corporation in Norwalk, Ohio, every annual renewal of his company’s health insurance plan since the Affordable Care Act took effect has felt like spinning a roulette wheel.
Durable Corporation’s plan, which Mr. Secor said had worked well for the company’s 37 employees, omits some benefits that are required to meet the health law’s minimum coverage standards. So far, the plan has been grandfathered in, allowing Durable to keep it — but if that protection ends, Mr. Secor does not know if his company can afford to continue offering insurance, he said.
“Rural areas like ours are seeing insurance companies just flee,” Mr. Secor, 59, said. “Until somebody comes up with something that addresses cost, you’re going to see a continual erosion of coverage. I don’t care which party it is. Let’s all get together and work on a better product because what we have now isn’t working.”
Bipartisan cooperation on anything has become vanishingly rare in Washington, but one recent effort offered a glimmer of hope: In December, the parties aligned to overwhelmingly support the 21st Century Cures Act. The law increased funding for disease research and included an array of other health care adjustments and changes.
One of them was a fix long sought by small-business owners to an obscure — but, for some, devastating — Affordable Care Act clause that prohibited companies from using pretax money to reimburse employees for insurance that they bought on their own. The Cures Act revived that arrangement, giving it a legal green light for companies with fewer than 50 employees.
The change came as a huge relief for Warren Hudak, 53, who immediately took advantage of it to provide the eight full-time employees at his accounting firm in Lemoyne, Pa., with a monthly allowance toward their health care costs. He would like to see a similar across-party-lines effort to curb health care costs.
“We have an insurance policy that would cover maternity and substance abuse treatment for my 11-year-old daughter but doesn’t cover my wife’s M.S. drugs,” Mr. Hudak said. “That’s insane.”
“The rising costs have taken a toll on all of my investments in people and equipment,” Mr. Gauss said.
Mr. Ryan and Mr. Trump have suggested that they are done with health care for the time being — no new bill or repeal vote is forthcoming, Mr. Ryan said — but Ms. Hunter, the Texas salon owner, thinks they will be forced back into the fray.
“I’m going to urge all of my senators and representatives to continue to work on this,” she said. “Waiting for it all to explode is a terrible solution.”
Mr. Secor, the Ohio manufacturer, also thinks the status quo is not sustainable. A growing number of his employees have dropped their coverage because they cannot afford the premiums and high deductibles, he said.
“People can’t afford the health care they need, and that’s becoming a crisis,” he said. “We need both parties to sit down at the table together and work it out.”