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In this Oct. 11, 2013 photo provided by Natasha Grach, Dr. Leo Lombardo poses for a photo in his clinic in Ventura, Calif. More small businesses than expected are signing up for health insurance on state exchanges that opened Oct. 1. Lombardo was surprised to learn from the California exchange that he's unlikely to get a break on insurance for employees he'll soon hire for his clinic. Under the new law, employers can get a tax credit if the average salary they pay is under $50,000. Lombardo expects to pay salaries of $80,000 and more to his staffers, including a nurse and physician's assistant. (AP Photo/Natasha Grach)