Perhaps the biggest effect of PPACA so far is the confusion it's created. Many businesses simply don't understand their choices under the new law.

“I'm very disappointed with the way Obamacare is being handled. People are so confused.” That's the word from Bruce Axler, principal at Axler Insurance Services in South San Francisco, Calif., where he works with businesses with two to 25 employees.

“Most of them are wondering what Obamacare is going to do to them,” Axler says. “Some of them need to do nothing; others will need to make changes in order to avoid paying a penalty.”

Businesses of all sizes have unhappy owners and managers, agrees Ken Neathery, owner of Lone Star Insurance Services in Sherman, Texas.

“They don't understand it, even though they've read everything they can get their hands on. The larger the employer, the more questions they have,” he says.

In small groups, Neathery adds, “the questions are 'What's going to happen? What's this tax I'm hearing about? Am I going to have to pay more?' People know things are changing this fall and they need to do something by next March, but they don't know anything else. We're doing our best to tell them that this isn't a catastrophe.”

Unavailable plan details

Neathery's task—like many others—is complicated by the fact that most states haven't yet released information about the costs and features of programs that will be available on government exchanges, with enrollment beginning Oct. 1 for policies that take effect Jan. 1.

In Texas, Neathery says, agents haven't seen product information, though they've seen estimates.

The situation isn't any better in California, Axler says. No one knows how much plans on the California exchange will cost or what features they'll offer. The state is also missing other important administrative rules.

“I've advised a lot of my clients to take health savings accounts,” Axler says. “They have, but now they're not sure what to do, and neither am I. The federal government has still not come down with a ruling on the maximum deductible for HSAs.”

In Jacksonville, Fla., Susan Guy doesn't know anything about exchange plan prices and features—or about January prices for plans that aren't on t

he Florida exchange.

“Nobody wants to quote a new group, because right now they can't get the data to write the risk,” says Guy, who is a benefits count executive at Greene Hazel Insurance Group, headquarte

red in Jacksonville. “We don't know what the group rates for January will be for plans that aren't on the exchange.”

High prices a near certainty