Anecdata:

I used to work at a small college where they had no bargaining power with insurance companies. Everyone who could be was on their spouse’s insurance for a larger employer, and - as was explained to me - the college “pool” was so small that one employee with a cancer treatment would blow premiums through the roof. Although I took the job for a bump in pay, the insurance premiums ate up the entirety of my raise, so I was basically making what I had made at another college that had better benefits, but less pay (and batshit admins, but that’s another story).

I would have *loved* to have had Obamacare back then. I might not have left that college for another state institution.