National survey shows nearly 7 in 10 small business owners oppose trading vital healthcare programs for tax breaks for wealthy as proposed cuts threaten to further burden Main Street

As the Senate Finance Committee announced deeper cuts to Medicaid funding in its revised version of H.R. 1, the One Big Beautiful Bill Act, a new national survey reveals small business owners overwhelmingly oppose healthcare cuts that could shift new costs onto employers who have long struggled with the soaring price of healthcare. The survey of 574 small business owners shows 68 percent oppose cutting healthcare programs to fund tax breaks for large corporations and wealthy individuals, with only 27 percent supporting the proposals.

The findings underscore how deeply small businesses depend on healthcare programs:

• 58 percent of small businesses surveyed have owners, employees, or family members who rely on Medicaid or CHIP coverage
• 56 percent have have owners, employees, or family members using ACA Marketplace coverage with premium tax credits set to expire—credits that H.R. 1 fails to extend

The Congressional Budget Office estimates that about 16 million people would lose coverage, because of Medicaid cuts, changes to the ACA Marketplaces, and the expiration of enhanced premium tax credits for ACA plans if this legislation is passed. Small businesses would be left to absorb these costs or lose competitive ground to larger employers.

“Small business owners have been crying out for relief from crushing healthcare costs for years, and Congress’s response is to make it worse,” says Small Business for America’s Future Co-Chair Walt Rowen, owner of Susquehanna Glass Company in Columbia, Pennsylvania. “These cuts don’t solve problems—they shift costs from government programs onto the businesses least able to absorb them, all while extending tax breaks for corporations that already pay lower effective rates than the corner store.”

The survey reveals the economic impacts of these cuts would cascade through Main Street:

• 52 percent of those surveyed said small businesses would face new pressure to provide employee healthcare coverage, directly hitting their bottom line
• 48 percent say cuts would make it harder to compete with larger companies in hiring
• 47 percent expect business costs to rise if they must provide coverage for workers losing Medicaid
• 43 percent predict higher employee turnover
• 41 percent anticipate productivity losses from absenteeism or untreated health issues
• 41 percent believe local economies would suffer as healthcare costs drain consumer spending

The findings come as small businesses face pressures from tariff uncertainty, supply chain disruptions, and a tax system that allows large corporations to minimize their obligations while Main Street pays full freight—a reality that tax proposals in H.R. 1 do nothing to fix.

“As a healthcare provider, I see the heartbreak of patients when they can’t afford care they desperately need. As a small business owner, I live it personally,” says Dr. Alexia McClerkin, a chiropractor and owner of The Wellness Doc in Houston, Texas. “I can’t afford health insurance for myself. The cost of every appointment and procedure comes out of my pocket. My three sons are covered by Medicaid, which has been my only lifeline to affordable healthcare for them. These cuts threaten to take away that coverage, adding another huge financial burden to my business and family.”

Rather than cuts that shift costs onto Main Street, small business owners want real solutions:

• 75 percent want policymakers to create more affordable health plan options for small businesses
• 63 percent support expanding tax credits for businesses offering coverage
• 55 percent want Medicaid access protected for low-wage workers
• 52 percent want to maintain and strengthen existing healthcare programs

“Congress has a choice,” says Rowen. “They can continue prioritizing tax breaks for corporations that use complex strategies to minimize their obligations, or they can invest in the small businesses that create two-thirds of new jobs and anchor local economies. Shifting healthcare costs onto Main Street while large corporations get another tax cut isn’t just unfair—it’s economically destructive and catastrophic to working people’s health.”

The survey was conducted June 9-16, 2025, and included small business owners from diverse industries across the country.