MIAMI - As President Barack Obama pushes Congress to pass a health care reform package, employers have two main messages to the nation's top policy-makers: Reduce costs and don't mess up small businesses.

Doctors, hospitals and pharmaceutical companies all have huge stakes in the outcome, as do the estimated 50 million uninsured. But so does a group that has been fairly quiet until now - the nation's employers.

"There's change that's needed, but there are moving parts that need to be examined," said Publix supermarket spokeswoman Maria Brous. "We want to make sure we are doing things that are well thought-out."

Publix and many other companies say that whatever is done to extend coverage to the uninsured, the government needs to cut health care costs.

"Get the costs down!" pleads Marlene Bernard, co-owner of Apricot Office Supplies in Miami Gardens, Fla. She recently paid $300 out of pocket for lab tests. "Who can keep affording this?"

Larger employers are generally able to continue to provide quality health plans even in a recession, and the bills aren't likely to affect them, but for small employers, it's another story. Many can't afford to pay for insurance now, and they fear the consequences of some proposals, such as the one that would add an 8 percent payroll tax to companies with payrolls of more than $250,000 a year that don't provide insurance.

"Oh my Lord! We couldn't survive," said Miriam Vilarino when she heard that proposal. Her family owns 14 restaurants, most called Las Vegas Cuban, in South Florida. "The only thing we could do is hike our prices and our customers are already suffering to the max. We are a very budget-priced family enterprise."

A study in June by the U.S. Public Interest Research Groups found that 76 percent of small businesses surveyed said their interests are not being recognized in the health care debate.

The study reported: "Small businesses who do not currently offer coverage would overwhelmingly like to, but are stymied by high costs, complications and red tape."

Some proposals would provide tax credits to employers of fewer than 25 full-time workers (House of Representatives) or 50 (Senate) to help them buy insurance, but that wouldn't help Las Vegas Cuban, which has more than 250 low-paid employees.

Steven Ullmann, who directs health policy programs at the University of Miami, said the details about how to reward or punish small businesses are still being hammered out in the halls of Congress.

A critical issue is what happens to those businesses on the edge of any new health care law, Ullmann said. If a firm's payroll or number of employees meant it might required to provide insurance or be taxed, the easy solution would be to lay off people to get below the threshold. "The consequences of these things can get complicated," Ullmann said.

One example: The payroll tax proposal was intended to encourage companies to provide insurance, but the co-owners of Apricot Office Supplies found themselves wondering if the tax wouldn't be cheaper than offering employees insurance - the opposite of what policymakers had planned.

For a small-business owner like Vincent T. Brown of Grace Funeral Home in Miami, the view can be simpler.

Brown offers health insurance to his four employees, paying 70 percent of the premium, because "it's the right thing to do."

But he knows that there are many self-employed or small-firm workers who have no insurance, and a major illness could be catastrophic for them. "It's critical this country find a way to protect them."

What follows are snapshots of a survey of employers' health care situation and their views about what Washington should be doing to improve the situation.

Davie's Field of Flowers

Donn Flipse, chief executive of Davie's Field of Flowers, has a simple message for Washington: "They want to cover more people, which is fine, if that's what the American people want. But how are we going to reduce the costs?"

His company pays $62,000 in health care premiums annually - a 12 percent increase from a year ago. "It seems like they just keep going up and up," said Flipse, 62, who founded Field of Flowers 19 years ago.

Field of Flowers pays half the cost of premiums for full-time workers, which means an employee must pay $114 every two weeks for individual coverage. Workers have to pick up the entire cost of coverage for other family members, which can be as much as $570 biweekly.

"Many employees simply can't afford it," Flipse said. "Out of 47 full-time employees who would qualify, only 24 are on the plan."

As a result, Flipse said Field of Flowers is in danger of falling below the percentage of participation level that its carrier requires. "We may not be able to get group medical insurance" if the number of participating employees falls much further, he said. If that happens, the company may have to lease employees through a Professional Employer Organization, or PEO, to ensure those workers get insurance.

"If we didn't do that, we may have to tell employees we can't get group medical insurance," he said. "That would be a shame. I'd hate for that to happen."

Flipse said caps on malpractice claims might help lower medical costs. He opposes any mandate that requires businesses of a certain size to provide health insurance. "It's a free market," he said.

Flipse favors moving away from employer-based insurance to a system that's either individual or government-based. "It probably makes sense to get the employer or company out of the middle of this," he said. "Whatever's less expensive for our company is what I'd prefer."

- Patrick Danner

Las Vegas Cuban Restaurants

Miriam Vilarino, a member of the family that owns 14 restaurants in Broward and Miami-Dade counties, said the business is "basically surviving by the grace of God" during this recession and can't afford to deal with healthcare costs.

Most of its 250 employees couldn't afford to pay for even part of the premiums anyway because they are at minimum wage or close to it, she said.

One proposal in the House of Representatives would require businesses with an annual payroll above $250,000 to pay an 8 percent payroll tax if they didn't offer coverage for employees. That would hit Las Vegas Cuban right in the pocketbook.

She said she'd like to see "some kind of middle ground" in health care reform, a compromise between those who believe in an all-government and those who believe in all-private health insurance. "I love when the people have the right to choose. I came to this country to seek that."

- John Dorschner

Tew Cardenas

Offering a quality health care plan is a necessity for the Miami law firm Tew Cardenas, said Thomas R. Lehman, managing partner. "To attract good people in a business like ours, you have to provide top-quality health care."

So all of the 80 people, including about 32 lawyers, on Tew Cardenas' payroll are insured through Blue Cross Blue Shield.

The firm picks up 75 percent of the cost, which will be $545,000 this year, up 16 percent from a year ago when it was $470,000, he said. To pay for that, Lehman said the law firm "held down" raises and subleased some office space it wasn't using.

Lehman doesn't believe the health care bills under consideration will impact businesses like Tew Cardenas that offer health care at a reasonable price.

"However, what we're watching with interest is how the law of unintended consequences plays out. Will Congress make the penalty for employers not providing health insurance so low that it encourages employers to do just that and put employees on (a) public plan as a cost-saving measure?"

He doesn't support a government-based health insurance. "Our experience with Citizens for windstorm is not exactly the poster child for government insurance."

- Patrick Danner

Barry University

About 1,000 of the Miami Shores school's 1,100 full-time workers get health coverage. "We still offer a free plan," said Jennifer Boyd-Pugh, associate vice president of human resources at Barry University. Three other plans require employees to pay a portion of the premium.

Self-insured, Barry belongs to a consortium of 10 other universities that negotiate prices with health care providers, which has allowed the school to keep percentage increases in the single-digits for the past three years.

In the reform debates, Boyd-Pugh opposes proposals ending employer-based coverage in favor of individual plans. "Individuals may be subject to pre-existing conditions that they may not be subject to under a group plan. … I don't think people will be able to afford their own plans."

- Bridget Carey

Amber and Amber

The South Miami law firm is "a mom-and-pop operation," a husband-and-wife team of Laurie and Henry Amber. They get health insurance as a small group. "We're paying $1,700 a month for a policy with a $2,000 deductible," Laurie Amber said. "We each have the $2,000 out-of-pocket because we're viewed as separate employees, not members of one family."

She supports a single-payer system in which everyone essentially would be on Medicare. "Everybody gets scared when they use words like 'socialized medicine,' but that's the wrong approach. Ask about Medicare. Everybody loves their Medicare."

None of the Congressional proposals back a single-payer plan, but some would create a government insurance option to compete with private payers. "I'm all for that," Amber said.

One Senate proposal would tax those who have expensive health insurance, like the Ambers'. "They talk about these being 'gold-plated plans,' but that's not ours. We really have a bare-bones. It's just expensive."

- John Dorschner

Kobi Karp

The Miami-based architecture firm believes "health care is imperative," said Director Speaker Christian Berthin. "It's a benefit that keeps any mid-size company competitive. The employee has to feel they're being taken care of."

The company, which has 55 employees, has seen "exponential increases year over year" in premiums, said Berthin. "It's always been difficult for us to be able to maintain healthcare that is of a high quality that offers different types of benefits and medical services."

Kobi Karp has a health maintenance organization plan through UnitedHealthcare. It used to cost about $200 a month per employee. Now, it's closer to $320, Berthin estimated. The company pays half. In the recession, because many employees feel they need to save money, about 10 percent to 15 percent don't opt for insurance.

- Niala Boodhoo

The Mortgage Experts

Danny Felton, owner of the Miami Gardens real-estate firm, said he provides coverage for his five employees. Healthcare is more personal for small-business owners like himself because he sees the workers every day.

He said he doesn't mind government requiring businesses to offer insurance, but the law should include provisions to protect smaller companies. "I think all companies should be required, but maybe there should be a reduction in costs for small companies."

- Joel Poelhuis

Apricot Office Supplies and Furniture

This small company in Miami Gardens has proudly insisted for years that its 13 employees should have health coverage, but that's getting difficult as the recession deepens and healthcare costs keep climbing.

"This year, we're paying 50 percent of the premium," said Marlene Bernard, the co-owner who handles insurance matters. "Next year, we might not being able to do that," instead offering employees the group rate, if they pay the whole premium.

She has one plea to Washington: "Get the costs down." With the high deductible policy Apricot has now, she paid $300 out of pocket for a simple lab test, and a mammogram and related tests cost another $1,000.

During a phone call to The Miami Herald, Marlene and her husband, Basil, weighed the meaning of a proposal to charge businesses like theirs an extra 8 percent on payroll if they didn't provide insurance.

That seemed high, said Marlene, but if the penalty were a bit lower, perhaps 5 percent, that would be a cheaper alternative than providing the health coverage they do now. Such a decision would be an unintended consequence of the bill, because law makers viewed the payroll penalty a way of inducing companies to offer insurance, not abandon it.

- John Dorschner