Republican Attacks on the Affordable Care Act Give Democrats an Opportunity to Court Small Business 

Here is a message Republicans can repeat with characteristic uniformity to bolster their increasingly absurd claim to be the “pro-business” party: If you are a small business owner, terminate your employees, shut down your company, and find suitable employment with a large corporation, or better yet, the state or federal government.  

Leading Republicans must already believe that instructing entrepreneurs to shutter operations and add to the unemployment rolls is a winning message for the November midterms, because several of them have all but announced their desire to see the closure of Main Street shops, bars, and restaurants. 

In June, Senate Majority Leader John Thune responded to concerns about cuts to Medicaid, the introduction of work requirements for the federal program, and the then-possible, now current reality of expired subsidies for buyers in the Affordable Care Act health care market with the terse smackdown, “The best health care is a job.” 

Thune and his colleagues, who utter the word “job” as if it were a magical spell that heals all social ills, routinely dismiss and demean the millions of “working poor” who clock at least 30 hours per week in low-wage jobs that do not provide health insurance. Sensitivity to the destitute is rarely part of the Republican forte. Still, they do boast of representing the interests of small business owners, often referring to them in such gauzy clichés as “the backbone of America.”  

Well, it appears that osteoporosis has taken its toll. With the expiration of Affordable Care Act subsidies, health insurance premiums have skyrocketed for the 22 million Americans who obtain coverage through the exchanges. Many of them are small business owners whose self-employment status precludes them from obtaining an employment-based plan and whose income disqualifies them from Medicaid. According to the Kaiser Family Foundation, nearly half of Affordable Care enrollees are affiliated with small businesses, and now many of them face the choice of going without insurance. They risk a catastrophic medical outcome if they forgo preventive care that they would otherwise receive, and the looming jeopardy of bankruptcy due to medical debt. Otherwise, they can close their business and hope for the best in a tough job market. As Mick Jagger sang in “Salt of the Earth,” “It’s a choice between cancer and polio.”  

Given that Thune’s statement provoked no Republican outrage, it is easy to assume most of his fellow Republicans agree. Mehmet Oz, the administrator for the Centers for Medicare & Medicaid Services, has become a parrot whose only utterance is “get a job” when discussing health care policy. He uses the phrase in every interview and speech when referring to Medicaid recipients. Still, he has issued no comment on how the lapse of the Affordable Care subsidies undercuts his claim that employment, or at least diligence, leads to good health insurance.  

Representative Robin Kelly, who is running for the Democratic nomination for the U.S. Senate from Illinois, injected sanity into the debate during a recent floor speech. Referring to a coffee shop proprietor and the owner of a wine production business in her district, Kelly relayed their concerns that, without the ACA subsidies, their employees could lose their health insurance. She then indicated that if Republicans were serious about “growing the economy and supporting small business,” they would strengthen the Affordable Care Act, rather than threaten it with a wrecking ball. 

Despite the efforts of Kelly and Senator Peter Welch, a Vermont Democrat who is a consistent advocate for health care for small business owners, the threat is real, owing not only to Republican indifference but also to a failure to rally the Democratic base. While Republicans are pursuing policies that crush the ambitions of the ordinary proprietor, the progressive left rarely, if ever, even utters the phrase, “small business.” “Labor unions” and “workers” populate every stump speech, making it harder for small business owners align with a political movement that frequently disdains capitalism, equating the entire free market system with, to use Bernie Sanders’s favorite bromide, “the billionaire class.” To be fair, Sanders supports the same policies to help small businesses as his colleague, Welch. But it’s important going into 2026 and 2028 that Democrats claim the mantle of small business and entrepreneurship 

As Will Norris has argued in the Washington Monthly, the Democratic Party should “champion the self-employed,” not only the legions of business owners but also the soaring number of freelancers and “gig workers” who navigate the modern economy and complicate traditional employment classifications and are notoriously on the hook for their own health insurance. He cites the National Bureau of Economic Research finding that 15 percent of workers are “independent.” Furthermore, MBO Partners found that part-time independent workers constitute 44 percent of the workforce. Those in the latter category refer to their “side hustles” as a means of bolstering income, and many express the good-old-American desire to turn the side hustle into a full-time career. This wish is increasingly fanciful in a country with a government that tells its entrepreneurial and self-employed citizens, “If you want the medicine that could save you or your spouse’s life, get a traditional job.”  

Political debate often feels antiquated, struggling to move under the weight of nostalgic calcification. While the right attempts to put the entire country into a pre-civil rights, pre-feminist, pre-LGBTQ movement time warp, a subsection of the left brandishes a vocabulary that was gathering dust in the 1970s.  

Wise leadership must offer fresh thinking that resonates with the experiences and anxieties of those who are yet to build their lives. The development of a small business/self-employment agenda could give bewildered Democrats the necessary ammunition to compete with the demagoguery of reactionary populism. The Monthly has been a champion of one clear way to help open markets: vigorous antitrust enforcement. 

Such a promising political ambition could begin with encouraging small business owners and the self-employed. It is impossible to reject the maxim that without good health, nothing else matters. Such a simple observation, it turns out, also applies to the economy and politics.