If they now offer insurance to their employees, should they continue? Can they actually afford to continue offering health insurance? If they continue to do so, can they keep the same plan, or do they need to make a switch? Can they afford to start providing health insurance to their workers if they didn't before? Does it make more sense to send their employees to the exchanges?

"There definitely is a lot of hand-wringing and head-banging going on out there, especially among those companies that are under 50 (full-time equivalent employees) or nearing 50," said Stuart Byron, a consultant with Affordable Care Strategies in Portland, Ore., a firm that helps firm analyze and strategize post-PPACA health insurance policies as well as provide general business counsel.

"Tracking and compliance reporting are generating a lot of paperwork," Byron said. "Analysis and anxiety related to health insurance costs and generally navigating (the PPACA) is increasing."

The volume of red tape and regulations can, indeed, be cumbersome, or at least appear that way to the uninitiated.

Byron said some clients, thanks in part to delays and legal loopholes, are taking a wait and see approach, putting off the necessary analysis and number-crunching associated with complicated questions like look-back periods, or what constitutes a full-time equivalent employee.

"We have clients with a number of concerns over FTE," said Byron, pointing to industries such as health care, restaurant and retail, where part-time employees hoping to fatten their paychecks typically pick up extra shifts all the time.

"Now companies need to track these employees, calculate their number of hours over time and establish new procedures and guidelines, once they figure out what it means for their business today and over time if they want to grow," he said.

The bottom line: Whether they offer health insurance or not, think it's a necessary and right thing, or that it's the worst law on the books ever, employers cannot ignore the issue.

That's because under the law, everyone must have health insurance or eventually pay a penalty.

By Jan. 1 2015, large employers, or those who employee 50 FTEs or more, must offer employees health insurance to those who work 30 hours or more each week, or pay a $2,000 per employee, per year penalty for all but the first 30 workers.

A number of employers are facing the sort of dilemma confronting Lawrence Katz, president of Jomar Café Inc., a Louisiana company that does business as Dot's Diner. Katz told members of the Senate Small Business and Entrepreneurship Committee earlier this summer his company is "caught in this unintended donut hole" because it employs 65 FTEs.

Katz told lawmakers that smaller restaurant owners can simply send employees to the exchanges without facing PPACA penalties, and larger restaurant companies already offer health benefits.

Katz was at the time considering various strategies including paying the penalty and covering the cost of those payments by raising prices 2 percent to 3 percent. He also was thinking about getting the company under the 50 FTE limit by selling its two, least profitable restaurants, which employ about 16 people, or unloading the business altogether.

Many small businesses, meanwhile, can relate to Gregg Caldwell, owner of C&G Tire and Auto Service in Chantilly, Va. Caldwell told a TV station that he offers health insurance to his employees as a retention tool. He's hoping PPACA implementation doesn't make his job any harder.

"We're feeling some confusion and nervousness. My wife spends hours on the paperwork," he said. "I don't want to alter my business around health insurance."

In the end, the majority of businesses probably won't have to change their present policies. But that's only because fewer small businesses nowadays provide health care, according to the Robert Wood Johnson Foundation.

According to its survey of companies that employ 50 people or less, the number of companies providing insurance dropped from 47 percent to 38 percent between 2000 and 2011. The proportion of all companies offering insurance slid from 59 percent to 52 percent.

John Lumpkin, the foundation's senior vice president, has a simple explanation for the trend.

"Small businesses just have so many pressures," he said. "When they're facing these economic crunches, one of the things they have to cut to survive is health insurance."

Small businesses have a harder time dealing with rising costs for two reasons, he said. Tighter profit margins, for starters. Additionally, insurance companies charge them higher rates. As any benefits broker or HR manager knows, that's because insurers view each company as a separate pool of risk, and smaller companies have fewer employees to spread out that risk.

"You're not going to get the same discount as a large business," Lumpkin said. "In the insurance market, the number of people that you have determines your leverage."

Whether the PPACA will halt the rise in premiums remains uncertain, but there are two prevailing, among many, theories. The PPACA requires coverage for everyone, including the aged, those who suffer from pre-existing conditions and people who are obese, or smoke. Reform detractors fear that will continue to drive up health care premiums.

But because the PPACA requires everyone to have insurance or pay penalties, supporters believe risks and costs will spread out over a larger percentage of the population, making insurance cheaper.

"That would be great," said Weeks, of the potential for lower health insurance costs and premiums. "Then I can focus on other issues, like client satisfaction and growing the business."