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The Affordable Care Act remains divisive. Its supporters argue the law will lower national healthcare costs and expand coverage to people who need it. Opponents say healthcare reform will raise taxes and burden small businesses while adding to the deficit.



The Commonwealth Fund touted the law's tax credits for small businesses and its medical loss ratio, which resulted in consumer rebates from insurance companies this year.



"The report highlights a nearly decade-long trend of declining health insurance coverage and rising costs for workers in small businesses," said Commonwealth Vice President Sara Collins in a statement.



"The Affordable Care Act should mitigate this trend by improving the affordability and comprehensiveness of health insurance both for small-business owners who want to offer health benefits and for workers in small businesses who can’t get coverage through their jobs."



Least likely to be offered coverage are low-wage workers in small businesses, the study found. One-third of employees making less than $15 an hour at small businesses could get health insurance through their jobs, and these workers were more likely than their higher-wage counterparts to report skipping needed medical care due to costs.



Commonwealth Fund President Karen Davis said the healthcare law's insurance subsidies and its incentives for states to expand Medicaid will help low-wage workers.



"The Affordable Care Act is targeted to address their needs as expanded health insurance options and support for those who can’t afford the premiums will assure that people have access to secure, affordable, comprehensive health insurance whether they work for a small or large employer," Davis said.



In 2010, 45 percent of small-business employees reported problems paying medical bills, and 46 percent reported skipping care because of its cost, according to the report. About one-third of workers in larger firms, meanwhile, had trouble with bills or skipped care.

