Employers in the 51-100 employee size bracket are anxious about the prospect of being added to the small group market that under the Affordable Care Act (ACA) currently cuts off at 50 employees (unless states opt to raise it). Small group health plans face tougher standards under the ACA than large plans, such as having to cover the ten essential health benefits, and therefore tend to be more expensive.
Under the ACA, beginning in 2016 states would no longer have the freedom to define small group; they would have to raise it to 100 employees.