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Employers still question just how much help they will get from the government under the new federal health insurance reform law, as the state prepares to initiate its local exchange program under the law.

House Majority Leader Steny H. Hoyer (D-Dist. 5) of Mechanicsville met with small-business leaders Aug. 5 at the Belair Mansion in Bowie to educate them about the upcoming Maryland Health Insurance Exchange, one of the state programs established in the legislation to allow group purchasing power for insurance plans. Maryland will provide four types.

The new law also requires businesses with 50 or more employees to provide health insurance or pay $2,000 per full-time worker if any employee obtains premium tax credits through the health insurance exchanges; the first 30 employees are exempt. Businesses with fewer than 50 employees face no new insurance requirements.

"Small-business owners need to be involved in making sure the [exchange] works for small businesses," said Terry Gardiner, national policy director for the nonprofit Small Business Majority of Sausalito, Calif., which helps educate businesspeople on key issues.

In Maryland, about 160,000 individuals and sole proprietors now purchase plans through the individual market; 400,000 buy through the small group market, which covers businesses with up to 50 employees; and 940,000 purchase through the large group market, said Elizabeth P. Sammis, interim Maryland insurance commissioner. Six holding companies cover the insurance policies within the state.

"You're not only here to learn but to learn and give responses," Hoyer told the business officials.

The state program still faces questions about whether it should offer separate exchange pools for individuals and small businesses and whether the employee limit for belonging to the small group market should expand to 100 employees, state officials said.

"Those in the state feel strongly that we can lead the way," Sammis said. "The federal-state partnership is key to making this work."

She added all members of Congress will fall under Maryland's exchange program.

Michael Gorman, president of Whitemarsh Information Systems in Bowie, said he is worried about stopping insurance companies from opting out of the program, while Art Widmann of Widmann Financial Services argued the legislation provides no hiring incentives to employers who are close to exceeding the 50-employee threshold.

"They would rather use technology than hire new people," Widmann said of such employers. He also pointed out employees tend to not notice insurance costs to their companies and have no "skin in the game."

Businesses are not seeing any measures to trim increases in health care or insurance premium costs, such as the growing practice of defensive medicine, said Fred Frederick of Fred Frederick Chrysler in Laurel. He referred to physicians who keep patients out of work while they evaluate tests or send them to specialist after specialist to ensure they are not sued for malpractice.

Sammis said Maryland's increased focus on health care information technology should spur communication among physicians and specialists and prevent unnecessary procedures. She also pointed to the state's push for a Patient Centered Medical Home to provide continuous, comprehensive and coordinated care through a partnership between patients and their personal health care team.

Another key part of the legislation is the 35 percent tax credit — set to rise to 50 percent in 2014 — for businesses with fewer than 25 employees and average wages of less than $50,000 that purchase employee health insurance. This credit will apply to more than 66,000 state companies, according to Families USA, a consumer health organization in Washington, D.C. Nonprofits will receive a 25 percent credit, increasing to 35 percent in 2014.

Hoyer called this reform essential to help U.S. businesses become more globally competitive.