As the Republican Congress and Trump target the health-care law, they should make small business insurance coverage their focus, said Otto.

“Small business must have a seat at the table,” she said. “They were not central to the first round of health-care reform. By making small employers the cornerstone of any ACA repeal and replace actions, the new administration can provide an economic boost to this sector while simultaneously meeting key health insurance coverage goals.”

The replacement plans floated before Congress took a break this week continue to emphasize the individual market, including who will get subsidies, how insurance will be sold, and when and how customers will be allowed to sign up for it. Republicans also are looking at putting caps on the decades-old policy that made employer-based health benefits the norm, by exempting them from income tax, and are considering lifting mandates that employers offer insurance that meets minimum coverage standards.

‘Patient-Centered Care’

Congress will “repair the damage Obamacare has done so employers can offer more personalized, patient-centered care” Republican Senator Lamar Alexander of Tennessee said in a January floor speech. Calls and an e-mail to new Health and Human Services Secretary Tom Price were not returned.

Obamacare did help small employers in at least one key area -- it grouped small businesses together into larger “communities” to expand the risk pool, thereby offsetting the kinds of premium surges that Ron Nelsen experienced when one worker would file a claim. In part because of this risk pooling, small companies escaped the sticker shock afflicting individual consumers of Obamacare.

Price Increases

Kelly Conklin, who owns a 12-employee custom woodworking shop in Kenilworth, New Jersey, said his insurance costs have risen by single-digit percentages since the Affordable Care Act came into effect, compared with a 126 percent price increase in one previous year. “I never found out which worker caused that,” he said. “I think they were trying to dump us.”

But the Affordable Care Act also presented challenges for small business, in part because of the law’s focus on individuals.

Subsidies that were simple to access for individuals, for instance, were anything but for small businesses. A tax credit was so limited and complicated that few businesses ended up using it. An insurance exchange was delayed so long that it ended up being almost useless in many states. The Internal Revenue Service cited the law in nixing a popular workaround, in which employers made tax-preferred payments to help employees buy individual insurance. Businesses with just a few more than 50 employees ended up with more paperwork, as they strove to meet the ACA’s definition of affordable.