I have been biting my tongue on other venues regarding this bill, which is a good sign it's probably not a good idea to discuss here.<p>Having said that, I'll put on my business hat and begin adapting. What's this mean for my startup?<p>1) Those of you who say the country is waiting for affordable insurance until startups take off are smoking crack. It's a great benefit, sure, but young folks don't need health insurance and startups are lucky to keep the lights on, much less pay fines to have everybody insured. The process of getting new employees may greatly be enhanced, but we need a thousand pre-employee startups for every one looking for employees, so that's where to look for impact, not with insurance. Not sure there is any impact at all for dirt-poor young startups. It should be interesting how the income requirements work -- can you get 15K in investments and keep that for operating? Or does that make you rich enough to start having to pay fines? Having said all of that (which you might hate), it's a great thing to keep your insurance.<p>2) Those of you saying that it's the end of Western free civilization are completely overstating the case as well. It's going to add 16 thousand new IRS agents, sure, and there will undoubtedly be new regulatory burdens associated with hiring employees and growing. The key metric to watch here is public debt. We're in a debt explosion and, to some, this just pours gasoline on the fire. If that assumption is true, and I believe it is, then watching the national debt rating could be an early indicator that different business configurations might be better than locating and operating in the states. (That doesn't mean you can't start out here, just once in growth mode getting the hell out of Dodge might be worth it) If the country is going broke, sooner or later somebody is going to come looking for any profits you might be making. I'm not saying it is or it isn't. I'm saying that it looks like a legit concern to me -- you can do the math.<p>3) Medical and insurance discussions will now become political ones. In other words, somebody has to say "no" in order for any kind of health service plan to work without going broke. It used to be those people were the insurance companies. It was a lot of fun hating the insurance companies. Now that we're regulating the insurance companies like utilities, however, that person is going to be some bureaucrat somewhere. Your best access to him, if you have an employee with a complaint or are looking for some kind of change, is probably through your Congressman, giving your local Congressional weasel even more power than he currently has. This means all startups, from dollar one, need to have some face time with their Congressperson if at all possible. Increasingly he/she is the guy who influences more and more details of operating -- bandwidth availability, insurance standards (now), investment criteria, etc.<p>I hope that sounded reasonably neutral. I certainly didn't feel angry while writing it. While the immediate impacts are very low, over time I think this is a major change in the country's direction. Small business guys need to pay attention.