NFIB’s Small Business Health Reform Principles

Date: March 22, 2021

Small businesses deserve health insurance that is affordable, flexible, and predictable. NFIB is committed to supporting legislative and regulatory solutions that better meet the needs of our nation’s small business owners as they purchase health insurance for themselves and their employees.

The principles here detail the path to affordability, flexibility, and predictability. 


  • Reconsider mandates that drive up the cost of health insurance and inhibit job creation.
    • Repeal or increase the employee threshold of the job-killing employer health insurance mandate.
    • Evaluate benefit mandates and health insurance requirements with a focus on affordability.
  • Equalize the tax treatment of health insurance for small business owners and self-employed individuals.
    • Allow self-employed individuals and business owners the same tax treatment as business owners and employees who receive group health insurance through their employers.
  • Support the ability of small businesses to provide health insurance coverage to their employees.
    • Codify the ability of small businesses of all sizes to help employees who purchase insurance on their own, without contribution caps.
    • Reform the Small Business Health Care Tax Credit to make it available for a broad range of health insurance options.
  • Eliminate unnecessary compliance burdens.
    • Eliminate outdated paperwork burdens and prevent new paperwork requirements.



  • Increase health insurance options for small businesses.
    • Enhance the ability of small businesses to help employees purchase health insurance on their own.
    • Allow small businesses to access similar health insurance opportunities as large businesses.
  • Permit innovative pooling arrangements.
    • Protect and expand the ability of individuals and employers to band together to form larger, more stable risk pools with greater negotiating power.
  • Improve Americans’ ability to save and pay for healthcare with tax-favored health accounts such as Health Savings Accounts, Flexible Spending Accounts, Health Reimbursement Arrangements, or similar tools that allow pre-tax dollars to be used for healthcare.
    • Eliminate unnecessary restrictions on tax-favored health accounts.
    • Enhance tax-favored health accounts to make them more accessible and useful to employees and business owners.



  • Allow individuals and businesses to keep the health insurance they currently enjoy.
    • Protect the employer-sponsored health insurance model and protect the ability of business owners and employees to purchase individual coverage insurance against attempts to impose a single payer healthcare system.
  • Prevent the disruption of markets where individuals and small business owners purchase health insurance.
    • Build a stronger market that services both business owners and employees who purchase health insurance on their own.
    • Ensure government-subsidized insurance options do not result in adverse selection or further destabilize the small group and individual health insurance market.

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