As states look to shrink the swelling ranks of those without health insurance, the crucial test for one approach gaining favor with policy makers is likely to be its impact on small business.

Massachusetts and Vermont are gearing up to introduce programs this year that require employers either to provide health benefits to their workers or make annual payments to help cover the uninsured. The governors of California, Pennsylvania and Illinois have proposed similar plans, and others are percolating in the legislatures of several other states.

Among the loudest critics of so-called pay-or-play requirements are business groups, which say the added cost would hurt legions of small businesses, ultimately forcing them to raise prices or lay off workers. But a closer look suggests that while some small businesses might be squeezed, a great number would be exempt from the rules. And many businesses and self-employed workers could even benefit by dropping their current health plans and picking up cheaper coverage through state-sponsored programs.

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