Tennessee Small Business Owners Joint Letter to Congress:

Don't Repeal the Affordable Care Act Without Replacement First!

Dear President Trump, Senator Corker, Senator Alexander and Congress:

Please stop your rush to repeal the Affordable Care Act without first protecting our health care.

A repeal of the ACA—without an adequate replacement that retains key protections—will stifle innovation by forcing individuals to stay in jobs to keep health insurance, draining the talent pool for small businesses and innovators who could have a dramatic impact on our nation’s economy.

Because of the ACA, individuals who want to shift careers or to start a new company know they are protected under the ACA and won’t face discrimination for pre-existing conditions or the threat of an insurer dropping them if a serious health condition develops. The ACA provides tax credits to small businesses—allowing small businesses to provide competitive benefits and attract top talent critical for growth. It means many of our employees have the peace of mind that they can find coverage when their employer may not be large enough to offer it yet. Because of the ACA, these individuals can take the risk to pursue the work they are passionate about, incubating new startups and spurring innovation.

A recent Treasury report released this month shows 1 in 4 ACA Marketplace consumers in 2014 were small business owners. In Tennessee, 25,350 marketplace consumers are self-employed and 16,960 are small business owners. Repealing the ACA without first replacing it - and offering details about how what we have will be protected and improved jeopardizes our business community and economy. Congress: let’s see the details of your replacement plan first, before you rush the repeal of what’s working about the Affordable Care Act.


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About the ACA & Small Businesses

Attract & Retain Great Talent

When people don't have health insurance it makes it harder for small businesses to attract and retain the best talent. Repealing the ACA without a replacement makes it harder on us to protect our greatest asset, our people.

It helps us stay competitive

Repealing the ACA without replacing it strips away tax credits many of us use to offer our employees health insurance.

Helps Startup & Innovation

The ACA exchanges mean it is easier to get insurance and not get stuck at a company because of coverage. Repealing the ACA without replacing it will stifle innovation and the startup community.

The Affect of Repeal on Jobs & Businesses

Repealing the Affordable Care Act will cripple our nation’s small business owners, their employees and self-employed entrepreneurs who have gained access to coverage under the healthcare law. The the health insurance marketplaces provide a vital source for coverage to countless entrepreneurs and small business workers who once struggled to access health insurance. The Affordable Care Act also enabled most states to expand their Medicaid programs, allowing the lowest-income small business employees to obtain health coverage.

The number of Tennesseans without insurance would jump by


people would lose their health insurance

Jobs Lost

Losing health insurance would also be devastating for family finances and hurt the economy. By helping pick up the tab for individual insurance and expanding coverage on Medicaid, the ACA has helped millions of Americans afford their care. If this support were withdrawn, people would have less money to spend on other basic necessities like food and rent. Fewer dollars spent at grocery stores and other businesses means 1.2 million jobs would be lost.


The ACA is also helping to end “job lock,” allowing workers who previously felt tied to their job by their benefits package to seek out their own entrepreneurial path or join thriving small businesses. The Robert Wood Johnson Foundation predicted 1.5 million more people would launch their own business because of the ACA - flexibility that will no longer be an option if the law is repealed.

- jobs lost

jobs in Tennessee would be lost


in lost federal health care dollars to Tennessee


  • Repeal would lead to the loss of 57,000 Tennessee jobs in 2019 alone and a $59.5 billion reduction in business output from 2019 to 2023. [Commonwealth Fund]
  • One in five people who purchased insurance coverage through healthcare.gov or the state insurance marketplaces is a small business owner or self-employed – meaning that repeal would force more than 1.4 million individuals, including more than 42,300 Tennesseans, to choose between going without coverage or finding a new job, hurting new small businesses and startups. [United States Treasury]
  • Thanks to the ACA, the number of uninsured small business employees dropped by more than four million between 2013 and 2015 and their uninsured rate fell from 27.4% to 19.6%. Repealing the ACA would hurt small businesses employees. Prior to the law’s enactment, small businesses and their employees comprised a disproportionate share of the working uninsured. Repealing the ACA would return us to the status quo. [Center on Budget and Policy Priorities]
  • Prior to the ACA, small businesses paid an average of 18% more for plans than their larger competitors, even though those plans had worse coverage. [The White House]
  • The ACA helped thousands of hard-working artists and farmers get life-saving coverage. By 2015, nearly 1.5 million people in rural America were signed up for marketplace coverage and by 2016, self-employed individuals like artists comprised 31% of non-group health insurance enrollees. Repeal would take us back to a time when a whopping 43% of artists were uninsured and one in five farmers was in debt due to medical bills. [Future of Music Coalition, United States Department of Agriculture, Kaiser Family Foundation]
  • Thanks to the ACA 8.7 million consumers in the small group market saved $2.0 billion in premiums from 2012 to 2015 and 7.7 million consumers received a total of $465 million in medical loss ratio rebates from 2012 to 2014. [Testimony from Richard Frank, HHS Assistant Secretary]



Jennifer Watts-Hoff, small business owner, Tennessee:

“As lawmakers meet to consider the repeal and replacement of the ACA, they need to consider the impact on the small business community, which drives innovation and economic development across Chattanooga, our state and nation...Because of the ACA, individuals like me, who want to shift careers or start a new company, know they are protected under the ACA and won’t face discrimination for pre-existing conditions or the threat of an insurer dropping them if a serious health condition develops.”
Chattanooga Times Free-Press, February 7, 2017


Ashley Saturday, service industry worker, Tennessee:

“This year, I’ve got a real shot at achieving my lifelong dream: striking out into business for myself and becoming fully self-employed, just like my dad. It breaks my heart to think of how many people before the ACA were prisoners in jobs or other life-circumstances they hated, but couldn’t escape because they couldn’t be sure they would still have healthcare on the other side. This isn’t just about keeping my dreams alive. It’s about keeping that American Dream alive.”
– The Tennessee Tribune, January 27, 2017

Kelley Deal, guitarist, The Breeders and Spoon:

“Before the Affordable Care Act, I was uninsured. I was a self-employed musician and I have a previous condition. So [now] if God forbid something happens, I won’t go bankrupt, I’m responsible for my healthcare, I can afford it and I can do what I want for a living.”
Los Angeles Times, January 11, 2017


John Arensmeyer, Founder & CEO, Small Business Majority:

“The Affordable Care Act has been instrumental in helping entrepreneurs and their employees who struggled previously to access or afford health insurance coverage. Anyone who would deny the positive impacts of the law on small businesses either hasn’t been paying attention or cares more about scoring political points with their base than about job growth in America.”
Small Business Majority, January 4, 2017

Renata Marinaro, National Director of Health Services, The Actors Fund:

“Many in our entertainment and performing arts community are worried about their insurance coverage and what this change will mean for the health care landscape. Changes that have been proposed may have serious consequences for [performers’] ability to access affordable, quality health insurance.”
The Actor’s Fund, January 2017


Micha Kaufman, co-founder and CEO, Fiverr:

“The Affordable Care Act created an option for many of the small business owners and entrepreneurs within the Gig Economy to have healthcare that was otherwise inaccessible. Even with the threat of repeal hanging over the marketplace, 6.4 million Americans have already signed up this year. Without the option of Healthcare.gov or something equally as beneficial, entrepreneurship and growth in the gig economy could curtail over time as would-be entrepreneurs or Gig workers are forced into careers that offer benefits.”
The Hill, January 6, 2017