Trump budget's cuts to Medicaid threaten small businesses and local economies.
What is Medicaid?
Medicaid is a popular and successful program, jointly run by the federal and state governments, that provides health care to over 75 million people. As the single largest insurer, Medicaid offers high-quality care at affordable rates and finances over 15% of all personal health care spending in the U.S. Enrollees include:
6.1 million people who own or work in small businesses
37 million, or 1 in 3, children
37 million seniors and people with disabilities
Medicaid provides parents and other adults economic security through health coverage that protects them from medical debt and allows them to stay healthy and work. Robust research shows that Medicaid leads to better birth outcomes, lower mortality rates, improved health, higher earnings, improved long-run educational attainment, reduced disability, and lower rates of hospitalization and emergency department visits.
What would the Republican plan to cut Medicaid mean for small businesses?
President Trump and Congressional Republicans are trying to significantly cut Medicaid by instituting a “block-grant” system that would weaken the program and cripple state budgets.
The Republican plan essentially shifts significant financial responsibility from the federal budget to state budgets, and cuts entirely the program’s additional federal support during times of economic crisis. To compensate for these severe funding cuts, states would likely have no choice but to institute draconian cuts to eligibility, benefits, and provider payments. Here’s how these cuts would impact small businesses:
Up to 21 million people will lose their health care coverage, including many small business owners. States would also likely be allowed to institute waiting lists or to limit the number of people with coverage. Poor seniors and people with disabilities would be at risk since health care costs for those people comprise almost half of all Medicaid spending. Provider payments would be cut, making it harder to find participating doctors.
Local economies will suffer job loss and billions of dollars will drain from local economies. The proposal would eliminate an estimated 3.1 million jobs between 2013 and 2020. The cuts would siphon billions of dollars out of local economies (both direct spending and multiplier effects), reducing consumer demand and local economic activity.
Health care costs will rise for everyone. Deep cuts to Medicaid will mean millions won’t get the coverage they need and will end up in emergency rooms without insurance to pay for their care, increasing the costs of uncompensated care. To cover these expenses, insurers will charge higher rates for their products, increasing premiums for small business owners and the self-employed.
State budgets will be decimated. Costs will shift to states that are already facing deep cuts to health and other programs because of budget crises. The 2017 budget would cut federal Medicaid funding by $1 trillion — or nearly 25 percent — over ten years. These cuts would grow to 33 percent by 2026. Currently, the federal government and states share in unanticipated costs. Under a block grant, states alone would bear them.
Small businesses in the Chicago and Los Angeles-San Diego region are getting fewer loans and smaller amounts from banks than in 2001.
A new report by Woodstock Institute shows stark disparities in loan rates for business owners in disadvantaged neighborhoods. Small business owners in low- and moderate-income areas receive disproportionately fewer bank loans than small businesses in more affluent areas.This lack of access to capital compromises a crucial source of economic opportunity and asset-building within lower income neighborhoods. Bank loans to businesses are necessary for community development because businesses without adequate access to capital fail to grow, cannot hire workers, and cannot make the kinds of investment often required of entrepreneurs.
“I needed a small loan to manage a surge of growth at my gourmet donut shop. It would’ve allowed me to triple my workforce with 24 new jobs and rescue a dilapidated corner of my neighborhood,” said Brad Keiller, the owner of Nomad Donuts in San Diego and a member of the Main Street Alliance. “I should’ve been a shoo-in for a small business loan. I have hundreds of thousands of personal capital invested, excellent credit, I’ve been in business for over two years and my revenue is through the roof. But even with the loan guaranteed by the SBA, banks don’t have enough incentive to lend to a business like mine. It’s been over a year and I’m on my eighth attempt to secure funding.”
The report, Patterns of Disparity: Small Business Lending in the Chicago and Los Angeles-San Diego Regions, examines bank lending to small businesses in the Chicago region as well as in the Los Angeles and San Diego region. It is the first in a four-part series of research reports examining small business access to bank loans in eight major metropolitan areas.Read more
The confirmation of Mnuchin would be a return to the failed policies that decimated small businesses, caused widespread job loss and destroyed the economy.
Today, small business owners, still struggling in the aftermath of the 2008 financial crisis, urge the Senate to oppose the nomination of Steven Mnuchin as Secretary of the Treasury. One of the architects of the Great Recession, Mnuchin has a track record of irresponsible economic decisions, and cannot be trusted at the helm of the US economy.
The Treasury Secretary is the leading cabinet official responsible for the economy, tax revenues, and the stability of our financial system. As the economic drivers of our economy, small business owners need financial stability and access to capital to thrive and create jobs. While on Wall Street, Mnuchin’s practices resulted in small business owners losing capital, having to downsize, and on many occasions, shut their doors completely. Small businesses cannot afford another economic crisis like the Great Recession.
Mnuchin, the co-founder and former CEO of OneWest Financial, a predatory lending institution, has built his success at the expense of small business owners and the communities they serve. Notorious for their “foreclosure first” policies, OneWest and Mnuchin engaged in extractive business practices that decimated small business owners and their communities. Sixty percent of the net job loss between 2007 and 2012 was in the small business sector. For businesses with fewer than 50 employees, employment declined 14.1 percent, compared to an overall employment decline of 8.4 percent.
During his tenure at OneWest, Mnuchin demonstrated a lack of commitment to fair and inclusive lending to small business owners. His financial institution had no significant branch presence in communities of color, rarely lent to small businesses, and has been accused of discriminatory lending practices.
“Given his history of predatory lending practices, and the very real challenges small business owners of color face in accessing and securing loans, it is profoundly disheartening that someone with Mnuchin’s track record would be offered this appointment,” said Michelle Sternthal, Main Street Alliance Deputy Director of Policy & Government Affairs.
Main Street Alliance and our small business members urge the Senate to block Mnuchin’s nomination. A Wall Street financier who accumulated massive wealth by sapping the revenues of small business owners and hardworking homeowners can not be trusted to steward the U.S. economy.
The proposed charter would undermine critical state protections and place small businesses at grave financial risk.
Today, Main Street Alliance expressed our concern over Comptroller Thomas Curry’s plan to enact a special purpose charter for fintech companies. Access to safe and affordable capital is a key policy priority for Main Street Alliance business owners.
Below is an excerpt from the letter to Comptroller Curry from MSA National Director, Amanda Ballantyne:
“While the growth of the fintech industry presents new opportunities for overlooked businesses to access capital, it also brings considerable risks. To date, irresponsible, and potentially predatory, lending practices have been documented in the online lending market. For instance, average APRs have hovered around 94%, with rates as high as 358%, according to a study by the Opportunity Fund. Fintech lenders have also included hidden or deceptive prepayment charges, opaqueness in repayment policies, and questionable brokerage practices. Not surprising, a 2016 Federal Reserve study reported exceedingly low satisfaction levels among business owners who used online loans (15%), attributable to the high interest rates and unfavorable payment terms of these loans.
For small business owners, the potential for fintech companies to inflict serious harm is even more pronounced since many critical federal consumer protection laws do not extend to commercial loans. Consequently, state laws are the primary, and in many cases, only, line of defense against the lending industry.
Robust and comprehensive federal protections are clearly needed to address the current regulatory gaps. However, rather than serve this function, we believe that the proposed charter--in extending bank preemption to fintech companies--would create a more perilous lending environment for small business owners by weakening existing state protections without offering comparable coverage at the national level.”
The letter warns “the OCC’s proposal would endanger small business owners by extending national bank preemption to fintech companies without offering comparable national protections.”
View the full letter HERE.
Small businesses brace for instability as Congress moves to repeal ACA and gut other health programs.
In a major setback for small business owners and entrepreneurs, the House voted today(227-198) to move forward with the repeal of the Affordable Care Act. Repealing the health care law would lead to unaffordable premiums, job loss, and budget cuts that would devastate the economy and harm small business growth.
“Before the Affordable Care Act, annual double-digit insurance premium increases meant instability in our business planning and growth," said Jim Houser, co-owner of Hawthorne Auto Clinic in Portland, OR and Main Street Alliance Executive Committee Member. "The ACA has stabilized our premium costs, raising our confidence enough to fill more full-time positions. Repealing the ACA will turn full control of health insurance pricing and coverage options back over to the largest insurance companies, and create the kind of instability that makes it challenging for businesses like mine to grow."
The House vote comes just a day after a joint report was released by the Treasury and Department of Health and Human Services finding that one in five marketplace enrollees is a small business owner or is self-employed. Small business owners and self-employed individuals are nearly three times more likely to use the ACA Marketplace to purchase insurance.
"As an entrepreneur and small business owner, I rely on the ACA to provide me and my growing family with affordable health insurance options," said Jeff Beck, owner of East Side Mags in Montclair, New Jersey. "The ACA makes it easier for me to sustain and grow my business because it means I have more funding available for inventory, marketing, and other crucial business expenses. By repealing the law without a providing a replacement plan Congress is pulling the plug on health insurance coverage for millions of Americans, including myself and my family. And it makes it more challenging for entrepreneurs like myself to start or grow a business."
Without the ACA, small businesses will be vulnerable to price gouging by health insurers, and will no longer have access to the bargaining power, risk pooling, or economies of scale that the ACA created. Costs would increase immediately for every small business that qualifies for the health premium tax credits. The higher cost of coverage for small business owners would mean less money to hire workers, making it harder for employers to add jobs–contributing to an estimated loss of 2.6 million jobs, mostly in the private sector.
Repealing the health care system is a misguided effort that will squash entrepreneurship, stall job growth and have a ripple effect throughout the economy.
Republican leadership's plan would send the health markets into a tailspin and cause massive job loss and economic destabilization.
Late last night, Senate Republicans chose to play politics with the lives of more than 30 million people when they passed a budget resolution with instructions to repeal the Affordable Care Act. A repeal of the health care law could cost nearly 3 million jobs and take away coverage from 30 million people. Small business owners would be left with skyrocketing health care costs, fewer protections or options, and an economy reeling from massive revenue cuts.
“Let’s be clear: rather than focusing on improving and making more efficient our healthcare system, the Republicans voted to move forward with a plan to destroy the insurance market and leave millions of business owners, their employees and their customers without coverage,” said Amanda Ballantyne, National Director of Main Street Alliance, a national network of small business owners. “Stripping subsidies and removing the individual mandate could lead to the ‘death spiral’ of spiking premiums, dwindling healthy participants, and fewer insurance companies offering coverage. This late-night vote was the first step towards the near collapse of the private insurance market.”Read more
“I can say without a doubt that my family and I are only able to afford decent health care coverage because of the subsidies built into the ACA."
At the headquarters of Zootility Tools, a Portland, Maine-based manufacturer, small business owners shared why they support the Affordable Care Act (ACA) and called on the state’s congressional delegation, especially Senator Susan Collins, to reject efforts by President-elect Trump and congressional Republicans to repeal the law.
Nate Barr, the owner of Zootility, explained how his business depends on his twenty employees having access to affordable health care and that they get it through the ACA.
“Repealing the Affordable Care Act would mean sicker employees, resulting in more work absences, higher health costs, and lower productivity for small business owners like me,” said Barr. “I am asking Senator Collins to do right by the people of Maine and block attempts at repeal.”
The Maine Small Business Coalition presented over two hundred letters to Senator Collins from small business owners across the state asking her to preserve health care reform.
“There are stories here from small business owners across Maine who couldn’t afford to provide their families with affordable health care before the ACA and can now,” said Ikard. “Our representatives are always talking about how they want to help small businesses. Preserving the core of the ACA is a great way to do it.”
Many, like Cathy Walsh, owner of Arabica Coffee in Portland, shared that they depend on the ACA in order to get affordable health care for themselves. “I can say without a doubt that my family and I are only able to afford decent health care coverage because of the subsidies built into the ACA,” said Walsh.
The event comes after a 51-48 vote by the Senate last night to begin the process of repealing the Affordable Care Act. Maine's Senators split their votes with Senator Collins casting a yes vote and Senator King casting a vote against. Senator Collins has publicly stated that any repeal of the health care law should coincide with an immediate replacement policy that would continue to provide health care for individuals currently covered by the law.
According to analysis by the Commonwealth Fund and Center for Budget and Policy Priorities, not only would 95,000 Mainers lose their health care coverage if the ACA is repealed, but repeal would lead to 13,000 Mainers losing their jobs and would take $565 million out of Maine’s economy in 2019 alone.
“Loss of all of that economic activity and all of those jobs would mean less money being spent at local small business like mine.” Barr said.
Small business owners fear that Mr. Trump will place his own financial gains ahead of the country’s financial and economic health
After promising to address the conflicts of interest presented by his domestic and foreign business dealings, Mr. Trump muddied the waters and sewed further doubt in his ability to govern in the best interest of Main Street Alliance member businesses and conduct himself with the same degree of integrity and propriety.
Amid mounting evidence that his businesses are heavily leveraged to domestic and foreign investors, Mr. Trump appears to be sidestepping the norms of the Presidency that exist to protect the office from inherently unethical individual conflicts of interest. Insisting he is not required to isolate himself from his business interests and that the Emoluments Clause did not apply to him, Mr. Trump rejected calls to divest from his business interests in favor of presenting his interpretation of the law.
“By commingling his business dealings with his duties as the incoming President in a way that no previous president has, Donald Trump is eroding the transparency and fairness we need from government,” said Amanda Ballantyne, National Director for Main Street Alliance, a national small business organization. “Mr. Trump’s outside interests and his heavy leverage to countries we do business with creates significant potential for corruption, abuse of power, and the delegitimization of U.S. authority around the world.”
Mr. Trump’s refusal to establish a blind trust while holding office is unprecedented and stands in direct conflict with his ability to govern in the best interest of small business owners and our customers. His financial ties and contracts held with large corporations put him in direct competition with small business owners, a position no President has held before him. And in doing so, he failed to ensure the American people and the business community that we can rely on the incoming administration to preserve the economic health and wellbeing of our nation.
"It's puzzling that elected officials, who promote themselves as business-friendly, would endorse repeal."
On Tuesday, January 3, as the US Congress convened, a group of Iowans gathered for a roundtable discussion on the devastating effect repeal of the Affordable Care Act would have on small business, seniors, health care providers and, in fact, all citizens.
The event was held at Palek Studio and Gallery in Des Moines with two additional Iowa Main Street Alliance members speaking:
Mike Draper, owner of Raygun spoke about his experiences after testifying before the House Ways and Means Committee back in 2009. He discussed access to health care as being a necessity for all and the disaster repealing the ACA would have on small business: from lowering the customer base due to discretionary spending being limited to being able to access affordable insurance policies for business owners. He finds it puzzling that elected officials, who promote themselves as business-friendly, would endorse repeal.
Claudia Hawkins of Hawkins and Hawkins Consulting related her experiences, including the ability to purchase health insurance through the exchange as a self-employed business owner. She also touched on the issue of tax credits and the use of Navigators to help guide them through the process.
This is a game-changer for D.C. small businesses.
The D.C. small business community scored a huge win today, with the City Council’s final vote of 9-4 to pass the Universal Paid Leave Amendment Act (UPLA). This comprehensive paid family and medical leave bill will guarantee about 530,000 business owners and their employees the ability to care for themselves or their loved ones without risking financial ruin. The program will be funded through a nominal employer payroll contribution of 0.62% per employee.
“This is a game-changer for small businesses. This paid family leave program is desperately needed for working families and small businesses alike,” said Ethel Taylor, the owner of the Doggie Washerette in D.C. “As a small business owner, if I'd had access to a program like this when my husband presented with stage 4 cancer, my business would have had the resources and staffing needed to continue to grow. This bill is good business for small businesses and for the District.”
The victory for D.C.’s small business community is a long time coming. For over a year, small business owners have joined advocates in supporting this economy-boosting legislation and rejecting attempts to impose harmful amendments. Most recently, Main Street Alliance members helped defeat an amendment which would have eliminated the insurance pool, shifting the full responsibility for absorbing the cost of employees’ paid leave onto the employer.
“I'm excited that the UPLA passed because it means small businesses like mine can finally get paid leave at an affordable rate,” said Doron Petersan, the owner of Sticky Fingers Sweets & Eats and FareWell Diner Bakery Bar, both in D.C. “If signed into law, this bill will help level the playing field for all businesses. Small business owners like me will now be able to proudly offer this benefit alongside big box stores at a reasonable cost.”
Despite this victory, the United States is still one of the only major countries in the world without a national paid family and medical leave program. Congress should follow the lead of California, New Jersey, New York, Rhode Island and now Washington D.C., and create a federal paid leave standard that supports small business owners and their communities.