ATLANTA -- Lisa Ehlers had landed her dream job. After 19 years teaching elementary school in Cherokee County, Ga., the Woodstock resident used her new master's degree in social work to secure a job at a for-profit agency that provides outpatient mental-health services to children and adolescents.
"I just loved it," Ehlers said of her time at Focus Counseling and Training. "I loved [owner Beth Brock] and the other employees -- but I couldn't stay." Ehlers, 44 and a single mom after her husband died in 2005 from cystic fibrosis, needed health insurance for her two boys, especially her 13-year-old, who suffers from bipolar disorder and requires costly medications and therapy. Brock could not afford to offer it, so Ehlers took a job at the larger Ridgeview Institute in Smyrna, which did.
Ehlers' story offers one small example of how the availability of health insurance can affect employers and employees in the most personal and even painful ways: Focus lost a dedicated worker it did not want to lose.
The story also can serve as a microcosm of America's larger health-care crisis -- the lack of affordable coverage for all -- and how the grand effort to solve the problem, the Affordable Care Act, also known as ObamaCare, is forcing some companies and employees to make tough business decisions.
Employers far and wide have criticized the ACA. They say health coverage shouldn't be government-mandated and add that the requirement that businesses offer it will have unintended negative consequences.
For Brock, the ACA will limit her hiring and cause her to put off the big plans she had to open a second office in Savannah, her hometown, she said.
It will "stop us from growing," she said.
Brock is angry because Congress and the White House "put something into law without knowing what it was or how it would affect the big picture." About 49 million people don't have health insurance because they can't afford it or don't see it as a priority. Some haven't been able to obtain it, even if they've wanted it, because they have pre-existing medical conditions. As a result, the uninsured often had to seek care in high-cost emergency rooms. Medical bills are the nation's No. 1 cause of bankruptcy.
The ACA is supposed to result in affordable health insurance for all Americans. And large employers -- those with 50 full-time workers or more -- are expected to lead the way by offering coverage. If they don't, they face a $2,000-per-worker annual fine, starting in 2015, a penalty that was delayed a year to give employers more time. The uninsured also will be able to seek coverage through exchanges.
Brock, whose 10-year-old firm has 40-plus staffers and was on track to pass 50, said she wants to provide coverage, but, "It's too risky.
"In staff meetings, she would bring it up and say, 'I really wish that I could provide it, but it would put me out of business,'" Ehlers said.
Brock said the best deal she has been able to find would cost her business about $300 per employee per month for single coverage -- with employees picking up the other half of the $600 total monthly premium.
About 14 of the employees of Focus, including Brock, would take the coverage if the company offered it, Brock said after taking a survey of her employees. That would come to more than $4,000 a month.
It might not seem like a lot, but it's still too much.
"Sometimes, we don't clear more than $1,000 a month after payroll," Brock said.
Brock buys her own basic health coverage, as does her husband. Together, they pay $1,100 a month.
The ACA, Brock said, "is stopping companies from growing. They made an assumption that all businesses over 50 employees could afford to offer health care, and that's just not true."
She said she knows there are small businesses who are profitable enough to afford to offer health insurance, but there are plenty who can't, "and they're not Ebenezer Scrooge."
Of employees like Ehlers who've left, she said, "I felt bad for them. I can't blame people wanting to get insurance."
Many businesses will find themselves in the same place as Brock, said David Cole, an attorney who specializes in employment law for Freeman Mathis & Gary in Atlanta.
"I think there is no question that [the ACA] imposes a burden on employers," he said. The law will require employers to offer coverage to more employees and to subsidize it so that it is deemed affordable for employees.
"This is a large expense many businesses have not had to incur under their current pricing structures, so it will likely reduce their margins or result in additional costs being passed on to consumers."
Some observers who support the mandate that employers offer affordable insurance to employees downplay the potentially negative impact on businesses.
The mandate affects a "relatively small percentage of employers," said Edwin Park, vice-president for health policy at the Center on Budget and Policy Priorities, a not-for-profit Washington, D.C.-based think tank. "This really doesn't hit a lot of firms."
According to a survey of employers by the consulting firm Mercer, 98 percent with 500 or more workers already offer a health plan, 92 percent of those with 200 to 500 do, and 80 percent with 50 to 200 workers do. Of those with 10 to 50 workers, 56 percent offer coverage, but those businesses are exempt from the mandate and penalty.
Park also said affected employers can offer health coverage and still grow their business by changing their "compensation patterns" -- perhaps offering less in salary increases.
David Bottoms, vice president of The Bottoms Group, an Atlanta benefits and insurance consultant and broker, said, "I do hear often from clients with around 50 employees that they plan to very carefully monitor their size to ensure that they stay below the 50-mark. For the employer who does not currently offer medical coverage, that 50th employee could be very expensive for the employer."
A self-described conservative operator, Brock said she watches her spending closely. She buys used furniture for the agency's offices. She rents space at very reasonable rates in what amounts to a warehouse/industrial park in a plain section of Woodstock.
Frills are the $40 in snacks that she might occasionally pick up for kids waiting in the reception area.
She says she's not getting rich, either, noting, "I don't have a second house," and, "I drive a used car.
"You don't get into this for the money," she said. "It's a calling." Still, there are costs, for computers, information-technology services, utilities and other typical expenses beyond rent and payroll.
There's not a lot left at the end of the month, she said, and raising prices isn't an option because that's regulated by insurers. Companies in other industries say raising prices isn't always possible for them, either, as competitors can then undercut them.