Before Obamacare, said one adviser, his clients typically received annual increases of 6 percent to 12 percent.
"This year we're seeing 30 percent rate hikes," he said.
The surge is blamed, rightly or wrongly, on the act's requirement for more comprehensive coverage and on its formula for calculating premiums (aka "community rating").
Costlier insurance could cause some employers to drop it and others not to offer it. But modest increases in overall health spending could relieve pressure on premiums.
* Second, most companies haven't made final decisions. Those who have go both ways.
Another adviser described a 250-worker car dealership with good wages but no health insurance; it will provide coverage and cut wages to help pay costs.
Another example involved a 60-worker manufacturing firm with wages of $12 to $15 an hour. It offered bare-bones policies with steep deductibles.
Confronting higher premiums for expanded coverage, the owner will drop insurance. He found the ACA "too complex," said this adviser. Wages will be increased somewhat.
With subsidies, workers might do better in the exchanges.
* Third, many firms are revising their business models to minimize insurance costs.
One favorite idea: Hold workers below the 30-hour weekly threshold requiring insurance.
Many part-time employees who work more (say, 35 hours a week) will lose hours. One adviser discussed a movie-theater chain that will keep most staff below the threshold. Many restaurants and hotels may do likewise.
Similarly, companies are striving to stay below the 50-employee ceiling that triggers the insurance mandate. Another adviser mentioned a client, an engineering firm with 48 workers, that had deliberately restrained expansion.
All of this clouds Obamacare's promise of universal coverage.
The Supreme Court's decision that states don't have to join the Medicaid expansion will reduce the number who get coverage.
What matters for small and medium-size firms is the gap between providing coverage and paying the tax penalties. The wider it gets, the more likely it is that firms won't provide insurance.
Some will also be deterred by the "hassle factor" of complying. The less private coverage, the more federal subsidies for exchanges will rise - and the greater the chances that individual workers will forsake insurance and pay the tax penalty.