Few people would argue that the nation’s health care system needs to be fixed.

But the devil is in the details, and that’s what worries small business owners who are leery of what health care reform will cost them.

Kevin Baron, director of government affairs for the American Small Business League, said small businesses and entrepreneurs aren’t opposed to changes because they’re on the front lines battling medical providers and insurance companies every day.

“The health care system isn’t working,” Baron said. “The cost of health care is out of control and needs to be contained. We’re moving in the right direction. The President laid out some pretty broad plans and some specific plans, but I think the biggest concern is how to address costs.”

Insurance premiums for small businesses have risen 110-120 percent since 1999 and are expected to grow 10 percent this year.

Small businesses – typically defined as those with 50 or fewer employees – already pay higher prices than larger firms for a variety of reasons, including state laws requiring small-group health policies to cover certain conditions, treatments and providers.

Also, larger employers often self-insure, are exempt from state regulation and have smaller administrative costs, according to the Kaiser Family Foundation.

“Small businesses don’t want to see an additional tax burden,” Baron said. “House Bill 3200 has language that calls for a tax on income of $250,000 and up, and that concerns small businesses since their personal income is tied to it, and this puts them on the threshold. Small businesses also see a mandate as another tax burden.”

A ‘great concern’

Mary Werner, owner of Tupelo Manufacturing, which makes contract furniture for the hospitality industry, said small businesses are under enough pressure.

Having wrangled with a recession that’s dragged on for nearly two years, small businesses don’t need anything else to worry about, she said.

Talk of universal health care is “a great concern,” said Werner, who is vehemently opposed to what she expects would be another badly managed government-run program.

“They want to borrow another trillion dollars? No!” she said. “They need to fix Medicare and Medicaid first. Why would they even try to create something new when they need to fix what the have now? It’s just mind-boggling.”

Werner, like many other small business owners, think that expanding health care coverage to the 47 million uninsured will hit them the hardest.

“I offer health care, but there are people here who don’t take it,” she said. “Some have insurance through their spouses, but some don’t have any and don’t want any.”

Basic health insurance at Tupelo Manufacturing costs employees $40 a week. The company pays about $15,000 a month to cover the balance.

Mandating insurance for all employees, as suggested by some health care reform advocates, would shut down many companies that simply can’t afford it, opponents say.

Ron Aldridge, the state director of the National Federation of Independent Businesses, said the mandates would be a “jobs killer.”

“Small businesses are in the position now where they’re having to cut expenses to the bone in order to survive in this economy,” he said. “Some have cut back on payroll, some have cut back on benefits, some haven’t posted a profit in 18 months. They’ve got all they can handle. If you start forcing them to cover all their employees, what’s going to happen?”

A company would either lay off employees, cut workers’ hours, delay hiring, cut or eliminate benefits or a combination of the moves, Aldridge said.

Raising prices for customers also would be an option, Werner said.

Tax credits?

Aldridge said giving employees tax credits similar to what employers receive would be one way to make health care more affordable. Eliminating the additional premiums small business have to pay also would help.

And both Aldridge and Baron say that attacking costs should be the key to any health care reform. Eliminating waste and fraud, implementing tort reform and allowing individuals and businesses to buy insurance across state lines are other key ideas that should be considered, they say.

“If the president is concerned about the waste and fraud in Medicare and Medicaid, why not attack that $600 billion now? Why wait?” Aldridge said.

The proposed insurance exchange mentioned by President Obama also might be worthwhile to consider, Baron said. Even the much talked-about – and feared – single-payer system can’t be dismissed right away, he added.

“I think the proposed exchange is good to see,” Barron said. “We need to find a way to get more competitive pricing, better deals. And the idea of the public option – if done right – could work. But it’s the details everyone is concerned about.”

Any plan that adds to the burden of small businesses should be nixed, Aldridge and Baron insist.

And small businesses are watching carefully how the debate plays out in Washington.