“Medical insurance is a gigantic value for small companies,” mentioned Amanda Ballantyne, the manager director of the Most important Avenue Alliance, an advocacy group for small companies. “It continues to be even after the passage of the Inexpensive Care Act.”

Many companies say they want Congress to supply more cash, and well being insurers say they help federal efforts to assist employers proceed their protection. “We consider Congress ought to present non permanent subsidies or direct monetary help for employers to guard the well being and monetary stability of hard-working People,” mentioned Justine Handelman, a senior vp on the Blue Cross Blue Defend Affiliation, which represents the nation’s Blue Cross plans.

Underneath the Inexpensive Care Act, insurers should return the surplus earnings if they don’t spend no less than 80 or 85 cents out of each greenback in premiums on prospects’ well being care. However even that provision strikes some as insufficient, given the present circumstances and the timing of the potential rebates.

“We’re in the course of a once-in-a-century well being and financial disaster, and it’ll take everybody stepping as much as do their half to get us previous it — together with medical insurance corporations,” mentioned Consultant Lauren Underwood, a Democrat from Illinois.

Dave Piersall, the proprietor of Lake Marine & RV, a boating enterprise in Woodstock, Unwell., used a few of his federal help on the $7,400-a-month insurance coverage invoice to cowl his staff. “We got here inside inches of being canceled,” he mentioned.

Though his enterprise has rebounded as folks have purchased boats to assist them address staying house, he worries concerning the coming chilly climate. “I’d be mendacity if I didn’t say winter is a scary time for the boat enterprise,” Mr. Piersall mentioned. “The well being care is the largest concern.”

And as onerous as he’s attempting to keep up insurance coverage for everybody, he’s additionally involved about efforts to cast off Obamacare. He was uninsured for a 12 months and a half after leaving a company job to start out the enterprise earlier than he may enroll in an A.C.A. plan that lined his Crohn’s illness.