First, I once worked for a small business, with 12 employees, that was a defense contractor and as such was obligated to provide insurance. Their insurance was the cheapest I've ever had ($40 per month) and had the best coverage I've ever had. It's why the only small businesses I will ever work for again will be defense contractors.
Second, I live in Texas. PPOs are no longer offered on the private exchanges here. Unless you have employer-provided insurance, you have to have an HMO, which I refuse to do for moral reasons. Even if it was legal, I wouldn't work at any company whose sole insurance option is to reimburse employees for the cost of individual plans because individual plans are not an option here.
This is simply the result of stingy, greedy owners trying to keep everything for themselves. The company I worked at before the defense contractor was about the same size, but not only did they not provide benefits, but they provided laughably low salaries (I was making $47k/year when recruiters were telling me I should be making $60-65k, and the defense contractor I jumped ship to paid me $65k), refused to provide any equity to anyone except to maybe the first two technical hires, and refused to seek any investment above the angel level because the owner wanted to keep ownership for himself.
If a business cannot afford to properly compensate their employees, they should not be in business. Period. Size isn't an excuse. And that means the <50-employee exception needs to go. And so does the <15-employee exception for EEOC (and some cities, including my own, have the same exception for their local non-discrimination laws).
If you're a small business, you should have three options: 1) offer full benefits and pay a competitive salary, 2) treat your staff as co-founders and give us both equity and public recognition as co-founders, or 3) you close your doors.