The Patient Protection and Affordable Care Act’s impact on businesses is getting worse, according to a survey by Express Employment Professionals. The survey of business owners, decision makers and human resource professionals found 63% believe the ACA will negatively affect their business in the future, up from 53% in 2014’s survey. Similarly, 62% believe the ACA will lead to less job creation, up slightly from 2014.

When asked whether the ACA will cause them to remain under 50 full-time employees, the threshold for the requirement to provide health insurance or face penalties, 25% said it would. The percentage was higher for businesses with workers currently numbering in the 40s; among businesses with 45 to 49 employees, 53% said they would try to remain under 50 workers, while 67% of businesses with 40 to 44 employees said the same.

“Almost two-thirds of business leaders are telling us that the Affordable Care Act is hurting them, and they’re saying things are getting worse, not better,” said Express CEO Bob Funk. “That fact should make anyone sit up and take notice. What they’re telling us is that the law isn’t just affecting their bottom line. It’s limiting their desire to hire new workers.”

The survey included 692 business owners, decision makers and HR professionals and was conducted in March 2015.