The Affordable Care Act (ACA) ushered in dramatic changes for small employer health plans. Through a review of policy decisions, premium and enrollment trend data, and structured interviews with insurance executives, brokers and small business representatives in six states, researchers reveal a market undergoing a significant evolution. They find that while trends in premium and offer rates have remained relatively stable, many of the ACA’s goals have been stymied by an expanded set of health plan choices for small business owners. The authors further find that these new options provide more affordable coverage for employers with healthy employees, but pose a risk to the small-group market as a whole.