A new survey of 745 small businesses shows little change in the size distribution of businesses between 2012 and 2016, except among businesses with 40–74 employees, in a way that is closely related to whether they offer health insurance coverage. Using measures of both size and voluntary regulatory compliance, the paper links these changes to the Affordable Care Act’s employer mandate. Between 28,000 and 50,000 businesses nationwide appear to be reducing their number of full-time-equivalent employees to below 50 because of that mandate. This translates to roughly 250,000 positions eliminated from those businesses.

More on this topic

BFI Working Paper·Mar 20, 2026

Physician Competition: Entry and Substitution

Joshua Gottlieb and Sean Nicholson
Topics: Employment & Wages, Health care
BFI Working Paper·Mar 18, 2026

International Comparison of Physician Incomes

Aidan Buehler, Joshua Gottlieb, Jeffrey Hicks, Lisa Laun, Mårten Palme, Maria Polyakova, Victoria Udalova, and Maria Ventura
Topics: Employment & Wages, Health care
BFI Working Paper·Mar 18, 2026

Predictably Unpredictable Inspections

Ashvin Gandhi, Andrew Olenski, and Maggie Shi
Topics: Health care