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Small businesses are independent establishments wholly owned by an individual, a family, or business partners. Small businesses are vital to local and national economies. In the aggregate, they have a very large impact on the nation, but individually, they are truly small. As such, the influence of small businesses could easily be overlooked, especially when health insurance legislation's focus is on individuals and large businesses.

The current American health insurance system is not sustainable because it increases the burden on large employers while providing a potentially untenable situation for small employers, does nothing to control rising medical costs, and does not provide universal insurance coverage. Specifically, the way the health insurance system works for small employers highlights these problems by providing optional guidelines with little assistance and no standardization for coverages among employers. Employers are then left to choose between providing potentially unaffordable coverage or forcing themselves and employees to find insurance on the individual exchange, which might not be any more affordable.

This Article explains the current health care and insurance laws and regulations, how it affects small businesses, why it is not a solution for the future, active proposals in Congress, and viable options for the future of small business health insurance.