One way to cover the costs associated with the new law would be to raise the price of each item sold about 4 percent and pass the costs along to buyers. “It’s ironic that our success meant we could grow,” Ms. Shein said, “and now we will be competing against smaller companies, with 50 employees or fewer, who will be able to charge less per item because they don’t have the financial burden of health insurance.” Prices are currently similar among local competitors, Ms. Shein said, and she says she believes the increase in her prices could affect her sales, possibly significantly.

Ms. Shein is considering a third option: outsourcing certain jobs to reduce the staff, because businesses with 50 or fewer employees will be exempt from the penalty. “We can outsource the cleaning and make the drivers independent contractors,” she said, “and we can cut the least profitable delivery routes, least profitable accounts or reduce the variety of items we create.”

It is important for Ms. Shein to make a decision soon on staff levels because the number of full-time employees a business has in 2013 will determine its status in 2014. If the business has 50 or more full-time, or full-time equivalent, employees, it has to provide insurance to any staff members who work 30 hours or more a week. Companies can average their number of employees across the full 12 months in 2013 to see whether they meet the threshold, or they can instead calculate the number of full-time employees by using any six-consecutive-month period in 2013.

Ms. Shein said she believed all workers should have health insurance, and she and her husband had wrestled with the problem for years. “We have offered health insurance to our employees in the past,” she said, “for preventive care, for financial protection, and because it doesn’t make sense for taxpayers when they end up in the emergency room.”

However, she has found many of her employees resistant to coverage that requires an employee contribution. “They are mostly young and healthy,” she said. “They don’t have a lot of extra money, and they would rather have a bit more in their paycheck than health insurance.” Also, she said, some of her Mexican employees prefer to go south of the border for inexpensive health care when they need it.

WHAT OTHERS SAY John G. Ebenger, an accountant with Berkowitz Pollack Brant Advisors and Accountants in Miami: “It is a challenging situation, especially since the details have not been fully worked out. The bakery could opt to bite the bullet and pay the penalty next year with plans to revisit the types of insurance that become available in 2014. With a year to plan, insurance companies will come up with more options for employers.”

Jonathan Gruber, an economics professor at M.I.T. who advised the Obama administration on health care reform: “Rachel and Steve face a difficult decision, but it seems that the third option, to reorganize production and outsource functions to end up with fewer than 50 workers, will be too expensive to make much sense. Offering insurance won’t cost much more than the penalty, and in an industry where many of their competitors don’t offer insurance, they could advertise themselves as a better place to work.”