Jackie Garson Howard started her fine-stationery business out of her Atlanta home almost 40 years ago. Three of her employees at Paces Papers, a...

Jackie Garson Howard started her fine-stationery business out of her Atlanta home almost 40 years ago.

Three of her employees at Paces Papers, a Buckhead store, have worked there for a dozen years or more.

Howard, 67, credits her retention of first-rate employees through good times and bad to the fact that she offers health insurance coverage.

Unlike many small business owners, Howard supports the 2010 health care reform law. “I’m very much in favor of it,’’ she says. “Morally, I think everybody needs coverage.’’

Jackie Garson Howard

Jackie Garson Howard

The U.S. Supreme Court will soon consider the constitutionality of the reform law, known more officially as the Affordable Care Act. It’s still a hot political issue two years after its passage, with all the Republican presidential hopefuls vowing to get rid of it.

Much of the opposition to the law has centered on its requirement for most individuals to obtain insurance. But small firms have complained about the mandate it imposes on them. The law requires small businesses with 50 or more full-time employees to provide affordable insurance coverage in 2014. (Paces Paper has five employees, so it would be exempted anyway.)

A national organization representing small firms, citing the insurance requirement, has filed a lawsuit opposing the reform law. The National Federation of Independent Business says the coverage mandate will prevent firms from creating jobs.

Surveys by NFIB over the years have repeatedly shown health costs being the No. 1 concern of small businesses. And insurance affordability is a prime reason many small firms don’t offer coverage to their workers – or are forced to raise the employees’ premiums, deductibles and co-pays.

NFIB says a majority of the organization’s members expressed opposition to health reform in a survey. Kyle Jackson, NFIB state director, said the main objection cited was the employer mandate.

Howard speculates that other small business owners oppose health reform because they are concerned about costs and other operating issues.

But she says, “I can’t get and keep the caliber of person I have’’ without insurance.

Howard doesn’t fit into a neat ideological category. “I’m not political,’’ she says. Though she’s a Democrat, she voted for Republican John McCain for president in 2008 because of his stands on foreign and defense policy.

But she supports President Barack Obama’s health care policies, and doesn’t want to see the reform law watered down.

Jackie Garson Howard has annually provided health care coverage to the employees of her Buckhead stationery shop, and she supports the requirement that other small businesses do the same.

Jackie Garson Howard has annually provided health care coverage to the employees of her Buckhead stationery shop, and she supports the requirement that other small businesses do the same.

Last week, a survey on the whole reform law showed sharp divisions over the legislation, with slightly more than one-third (36 percent) of adults saying they want the law repealed and 21 percent saying they want it to remain as is. Another 25 percent would like to see certain elements of the law modified, according to the poll by Harris Interactive/HealthDay.

But while poll respondents were split about the law as a whole, many strongly supported key elements of the bill — with the exception of the individual insurance mandate, which they strongly opposed.

Slightly more than half – 53 percent – supported requiring all employers with 50 or more employees to offer insurance to their employees or pay a penalty. And 70 percent backed providing tax credits to small businesses to help pay for their employees’ insurance.

Under the Affordable Care Act, small businesses with fewer than 25 full-time-equivalent employees may be eligible for tax credits to assist in the cost of health insurance. Howard says she was unaware of those tax credits, and would consult with her accountant about them.

This year, Paces Paper hit a health insurance wall typical of small businesses: Its premiums rose by hundreds of dollars per month.

But true to her beliefs, Howard retained the coverage despite the increase, and continued paying the majority of the insurance premiums for her employees.

The increase, she says, comes out of her pocket. But she adds, “I’m choosing to take care of my employees.’’

Deesha Patel is a second-year Master of Public Health student at Emory’s Rollins School of Public Health. She is interested in health journalism and medical writing as well as epidemiologic research.


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