President Barack Obama waves to supporters after his election victory speech on November 6, 2012 in Chicago, Illinois. - 

Something's gotta give -- that's how John McGowan sees it. "My concern is that health care premiums last year for our company went up 38 percent," he says.

McGowan, who runs the Philadelphia-area business GasBreaker, believes the Affordable Care Act has only increased his health costs. If this keeps up, his employees are going to pay.

"I know that everybody is going to pay a lot more for it, ultimately or have something that is a lot less than what they are used to here," he says.

The Urban Institute's Linda Blumberg says McGowan's 38 percent premium spikes are becoming a thing of the past as insurance companies now must provide states with actuarial evidence for rates to increase by more than 10 percent. "So we should see a lot more stability, year to year," says Blumberg.

Of course not all business owners are upset about Obamacare. Ken Weinstein, who runs two Philadelphia restaurants, hopes the law will ultimately make insurance more affordable. Without that, Weinstein says his business is exposed: "Anytime an employee is not able to make it into work, we are absolutely scrambling. Or in the worst case scenario, we are working with less employees and we aren't able to satisfy our customers as well as we should."

While opinions vary, John McGowan says no small business owner really knows what to expect, "to some extent, we are all in the dark on exactly whether the promise of the affordable portion of this healthcare act is going to be the reality."

What they do know -- all too well -- is that right now health care isn't very affordable for them or their employees.

Follow Dan Gorenstein at @dmgorenstein