Perhaps nothing is more uncertain right now in the United States than the future of health care. One cannot open a newspaper or visit an online news outlet without reading a headline about the national health care debate.

While Republicans in the Senate failed to repeal and replace the Affordable Care Act (ACA) earlier this summer, both sides continue to struggle and articulate the long-term benefits and feasibility of their very different approaches. It is clearly one of the biggest challenges facing our nation today and an issue that, as it is unlikely to be settled anytime soon, promises to have a major impact on business owners and executives for the foreseeable future.

Each quarter, KeyBank surveys owners and executives of middle market businesses (those in the $20 million to $4 billion revenue range). We do this to gain insight into selected topics and find out what they think about their companies in light of leading economic indicators, as well as the current political and business climates. We surveyed 300 middle market business leaders in early June, with a focus on health care and the uncertainty over how proposed regulations might impact businesses.

At the time of our poll, health care reform focused on differences between the Affordable Care Act (ACA) and the American Health Care Act (AHCA). The Senate had not yet released its version of the new AHCA. However, our survey respondents had already seen the House version of the bill and also heard how the Senate planned to modify it.

General polls from the same period, such as the one from USA Today and Suffolk University on June 28, showed that only 12 percent of voters approved of the Republican plan. While voters largely did not approve, 42 percent of the business owners and executives we surveyed were in favor of the Republican plan. While this may or may not come as a surprise, it is important to remember that business owners and executives wear two hats – they must consider the business impact of changes to health care, but they are also consumers who worry about securing the best possible care for themselves, their families and their employees.

Our survey also asked respondents to identify expenses which, if changed, had the biggest impact on their businesses. The top four on the list were employee health care, followed by labor costs, information technology and human resources. Notably, most of these expenses are largely out of the control of the business owner or executive, so it is no surprise that they are a source of concern. Other expenses, such as research and development, energy and debt interest, are more predictable and were rated as less of a concern by those surveyed.

In a related question, we asked respondents which expenses they expected would substantially increase in the next six months. The top four are identical to the earlier responses, which tells us that the same expenses that cause the greatest impact are the one’s middle market business owners and executives are expecting to increase – not an ideal situation.

Uncertainty is the overriding theme in the discussion around health care. Consumers and business owners are wary, and no one can accurately predict what will happen. Despite all the promises of lower costs and improved service or coverage, the current infighting amongst our lawmakers does not bode well for a balanced solution that will ease the fears of middle market businesses across the country.

Your Banker Can Help
So what are middle market businesses to do? Ask your banker for help. Despite the murky health care waters, there are still many ways that a bank can help your business, even when mergers, acquisitions and expansions slow due to the uncertainty and concern over health care costs.

Your banker should be poised to guide you, help you make the best decision and implement the right programs to address the economic and political factors that affect your business every day. If your banker is creative and dynamic, they will go beyond financing solutions to enhance technology and safety for your business, and help streamline costs and cash management to operate more efficiently.

With little to no control over health care and labor costs, business owners and executives should focus on those areas where they can make effective change. Improving cash flow with programs such as payment cards, ensuring the proper financing is in place to meet both short- and long-term needs, and managing interest rate risk are just some of the ways businesses will succeed in the coming months.

Jeff Hubbard is KeyBank’s market president of Connecticut and Western Massachusetts.