Small business wields power in U.S. health debate

The group has not taken a position on mandates that individuals buy insurance and held a briefing to explore the issue this week.

Stottlemyer said the group backs proposals letting small businesses pool together for greater leverage with insurers.

"All three (candidates) are talking about it, but they are not at a deep detail level right now," he said. "We're urging them for more details."

In general, the Democrats seek universal coverage by building on the current employment-based insurance system, while McCain wants to encourage individuals to buy insurance outside of work by revising the tax system.

McCain proposes eliminating the tax breaks employees receive by getting insurance through work. Individual buyers of insurance don't get those tax benefits.

In the small-business community, about half are forced to buy their insurance individually, which is far more expensive than group plans, Stottlemyer said.

"There is some equalization that we think needs to take place," he said.

Experts say that taking away the employer tax incentives could encourage employers to abandon health insurance altogether. Critics also worry that more flexibility in state insurance regulations may dilute consumer protections.

Either way, small business will take a lead in influencing the debate.

"They were a major player in dumping the Clinton plan. They don't want to be the enemy this time," Henry Aaron, a health-care economist at the Brookings Institution, said. "They know it's a national problem."