There's one inescapable fact. No matter what you think of the politics of the healthcare reform law pushed through by the Democrats, small business has the task of dealing with the reality of the reforms now. Indeed, business owners could well find themselves caught in the middle. On the one hand they are expected to provide additional coverage to their employees. But with the increase in the coverage is likely to come a bigger bill for premiums. You never get something for nothing in the insurance world. So what exactly are businesses expected to deal with? Ignoring the changes to be phased in over the next few years up to 2014 when the entire system is supposed to be up and working, there's a new appeals process, dependent coverage is going up to 26, insurers can no longer refuse coverage for children with pre-existing conditions, and there are new free preventative check-ups.

So how is this likely to work out? Take the question of the free preventative check-ups. The idea is simple. If you identify more health problems in their early stages, treatment is usually effective and you avoid higher, long-term costs. For example, there will be free mammograms for female employees. If a simple surgical procedure removes a small growth, this potentially avoids major surgery with all the lost productivity. Apply this across the range of diseases and disorders that may be caught early and you have major cost savings which will be reflected in lower premiums. But if children with existing conditions are now to be covered or adult children may opt back into their parents' plans until 26, this is likely to drive up premiums.

The problem for employers is how to handle the uncertainty. If there's a choice on whether to recruit new staff, are you now hiring based on whether they look healthy? This is something you should sit down and discuss with your insurance agent. Small business insurance is all about balancing costs. Remember that this is affecting everyone, including your customers and clients. They may also find their premium rates rising, putting pressure on their spending power. You may find your own costs rise and there's pressure from your customers and clients to reduce your prices for goods and services. You may have seen that McDonald's is saying it may drop its health plans if forced to raise the low annual limits. The politics of these threats may work to the advantage of big employers but it hardly help the small business. This makes your agent a particularly important person. You need to get as much information as possible on current trends. Just as important, if you have not already done so, join a small-business group or association. This should give you access to more information. Then get small business insurance quotes from as many companies as possible. Spreading the net wide gives you the best chance of finding the right plan. Then you can plan hiring and your marketing policies on pricing. Getting everything right for the next 12 months is critical. Once we are through this, the trends in policy rates should become more clear and you can make better plans.