One year after the passage of sweeping health insurance reform legislation, the lasting impact of the Patient Protection and Affordable Care Act (PPACA) on the small-business community remains to be seen. However, according to a new study by the National Federation of Independent Business (NFIB), the overwhelming majority of small-business owners don't expect the law to reduce cost or regulatory burdens, and nearly two-thirds agree that the law will result in premium increases but not in better care.

When it comes to health insurance reform, perception is reality. The majority of America's small employers simply do not believe that the law will accomplish most of what it promised to do.

The first significant tangible consequence of the new law for the small-business community is the elimination, or looming elimination, of health plans that small employers purchase; 12 percent reported that their plan is or will be on the chopping block, and that percentage is likely to rise when the law takes full effect. Other major study findings are summarized below, according to the NFIB:

Small Employers Who Offer: The net number of small employers (those employing 50 or fewer) who provide coverage is largely unchanged (42 percent) from the number offering prior to the passage of PPACA, suggesting that the law did not provide significant reason for non-offering employers to begin covering employees. Small employers who do offer health insurance are also unlikely to drop their coverage over the next 12 months. Generally speaking, employers that offer health insurance have a far more pessimistic view of PPACA and its anticipated effects, as compared to those who do not offer insurance.

Changes to Plans: Twenty (20) percent of small employers currently offering coverage expect to significantly change their benefit package and/or their employees' premium cost-share the next time they renew their health-insurance plans. Almost all expected significant changes involve a decrease in benefits, an increase in employee cost-share, or both.  Employers who even slightly alter their benefits packages to reduce costs will likely be exposed to more regulations and cost increases in the future.

No Incentive to Start Offering: The new law was expected to increase the rate of employer-sponsored insurance. However, today's study suggest that PPACA will not encourage non-offering employers to begin providing coverage; nearly 87 percent of non-offering employers say they are either "not too likely" or "not at all likely" to be offering coverage a year from now, suggesting that the law's incentives to providing coverage are ineffective.

The Tax Credit: The law's tax credit for small businesses acts almost exclusively as a windfall for those who currently offer health insurance rather than as an incentive to encourage its purchase. Considering eligibility and awareness issues, the full credit incents, but does not necessarily change behavior, of only about 2 percent of small employers having fewer than 25 employees.

According to the Administration's estimates, nearly 4 million small businesses would be eligible for the tax credit. However, today's study found that only an estimated 245,000 (out of 5,228,000 employers with fewer than 25 employees) are eligible for a full PPACA tax credit and 1.165 million are eligible for the partial credit – less than half of the estimate produced by the White House.

So, the end result is that some benefit and some don't. Has there been improvement in some areas of coverage? To a degree, yes, but the burden of proof has been on the government. And so far the results are lacking. Costs are increasing, not decreasing as promised. More regulations are being made up daily versus using existing laws that if reworked could help streamline the process instead of strangling health care providers, insurance companies, businesses and the American public.

Is there room for improvement? Yes, quite a bit. But the overall affect of the current federal plan is more onerous than it is helpful. Maybe cooler heads will prevail as time moves forward, but the concept of health care for all as a right needs serious soul searching by those promoting it as a legal agenda. The Constitution names only a few rights, and health care is not named as one of them.

Can the health care and insurance industries do a better job of service, delivery and improvement of care? Yes, they can. But the government does not need to take ownership – just provide direction without heavy-handed mandates.

Viewing the future is difficult. It takes perception, vision, insight, ethical conduct and a strong desire to see the greater good accomplished. It's never easy and often can be painful. Change is never easy, and based on how much is required, the end results are sometimes different than the original intent.  

When the Founders were drafting America's operating manual, they did have the foresight to draft controls. Now, 235 years later, looking forward, the concept of Constitutionality is more important than ever before.