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PHOENIX -- Just when Arizona's economy is rebooting, the implementation of the Affordable Care Act will force the state's small businesses to make tough decisions, said John Mathis with the Thunderbird School of Global Management.

Mathis said businesses with 50 employees or more will have to offer group health coverage. He believes many will trim staff to fall below the line.

"It depends on what type of small business it is but either way their growth is going to be stymied," he said. "One [way] by the health care ceiling and two, getting the capital needed to substitute for labor."

Mathis said America won't truly know the full impact of the health care reform bill, commonly called Obamacare, until the presidential election is over. It will be felt globally, he predicted.

"[It's] going to add to the European uncertainty and every other uncertainty that is now causing businesses and consumers to be cautious in terms of spending money," he said.

Jim Cross, Reporter

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