A patient who was in today happened to ask if/how Obamacare was affecting my practice. Truth is it has had little impact on my day-to-day practice aside from a noticeable increase in bureaucratic hurdles & paperwork, as long as you don't count the headaches and hassles of adopting an EHR. So far. But it will starting in 2014. Part of the plan to 'slow-boil the frog' (that's not a reference to Frogboy).
However, he related that it has already had a dramatic impact on his business, even before it is subject to it. He owns a company that serves the construction industry. He had about 150 employees roughly 3 years ago but had contracted to 48 employees by early last year, mostly as a consequence of the housing recession.
The housing industry and construction in general is starting to recover a bit here and he was considering starting to hire again to enable re-expansion of his business. He convened a meeting of his legal & accounting advisors 2-3 weeks ago and learned that due to Obamacare's requirements adding a 51st employee would immediately increase his personnel costs by $140,000 per year, over and above that employee's direct compensation.
He's going to stand pat @ 48.
I know of damn few small companies that could 'afford' to be that successful. A hurdle of that magnitude will guarantee that very few small companies grow any bigger than that magic number of 50 employees. All they can hope for is to look attractive enough @ 50 employees to garner acquisition interest.
Social engineering legislation of this kind is seldom, if ever, really thought through before passage. Of course, it should be no surprise since none of our Senators or Representatives even read the damn thing before casting their Yes vote.