16 Years After the Affordable Care Act, Small Businesses Warn Coverage Is Slipping Out of Reach Again

FOR IMMEDIATE RELEASE
 March 23, 2026

As subsidies expire and uninsured rates rise, Main Street Alliance calls for bold federal action to stabilize and expand health care access

Washington, D.C. — Sixteen years after the passage of the Affordable Care Act (ACA), small business owners across the country are warning that the promise of affordable, accessible health care is once again under threat.

New reporting shows that as enhanced ACA subsidies expire, millions of Americans are losing coverage or facing sharply rising premiums, leaving families and entrepreneurs increasingly exposed to the financial and personal risks of going uninsured.

For small business owners, the consequences are especially acute. Without the scale of large employers or the safety nets available to low income households, small businesses are often forced to navigate both the employer and individual insurance markets, absorbing rising costs while trying to provide stability for themselves and their employees.

That dual role makes small business owners uniquely powerful validators in the health care debate. They are not abstract stakeholders. They are job creators, community anchors, and firsthand witnesses to how policy decisions translate into real economic pressure. When they speak, lawmakers hear lived experience.

Main Street Alliance, which played a key role in advocating for the ACA’s passage, says that same leadership is needed now.

“As we mark 16 years since the ACA, we should be building on its promise, not watching it unravel,” said Richard Trent, Executive Director of Main Street Alliance. “Right now, millions of Americans are living with a quiet, constant fear. The phone call from the doctor. The bill in the mail. The moment something goes wrong and there is no safety net. For small business owners, this is not theoretical. It is the difference between staying open or shutting down, between hiring or cutting back, between stability and chaos. We have seen what progress looks like, and we know what is at stake if we fall backward.”

Main Street Alliance is urging federal lawmakers to meet this moment with the same urgency and ambition that defined the ACA’s passage. That includes stabilizing and expanding subsidies, addressing underlying cost drivers, and pursuing bold solutions that ensure affordable coverage is a reality, not a gamble, for working families and entrepreneurs.

“Sixteen years ago, this country made a choice to move forward,” Trent added. “Small business owners helped lead that charge, and we are ready to do it again. But this time, we need leaders in Washington who are willing to think as big as the problem actually is.”

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