The Agenda for America's Entrepreneurs: Quality Jobs

Entrepreneurship is a potent force for positive change in a diverse society and economy—from addressing long-term unemployment to providing high quality jobs and helping revitalize distressed communities. A healthy entrepreneurial ecosystem provides innovative pathways for women, Black, Indigenous, and people of color (BIPOC), veterans and immigrants to enter the American economy and build income and independence. 
Small businesses need a modernized and robust benefits infrastructure that promotes wealth creation, financial security and quality jobs for those who do not work for large organizations and those who are self-employed. A robust benefits infrastructure means access to affordable healthcare, paid family and medical leave, childcare and retirement savings. Without these support structures, small businesses cannot properly compete or contribute to their local and state economies in a meaningful way. 

Lower prices for hospital visits, physician services and prescription drugs

• Extend Medicare pharmaceutical drug inflation rebates under the Inflation Reduction Act to the private market, which penalizes drug manufacturers for raising prices faster than inflation. This will also discourage manufacturers from increasing prices in the commercial market to offset lower prescription drug prices negotiated by Medicare. 
• Block hospital mergers and acquisitions that are likely to increase patient costs while not improving medical quality or outcomes. Ensure vertical integration between hospitals and physicians is done to improve patient outcomes, not to bolster profits and market power. 
• Block anti-competitive hospital contracting practices with insurance companies, such as large hospital chains using their market power to force insurance companies to include certain high-cost providers in their networks. 
• Stop abusive hospital pricing by banning predatory billing practices that are not disclosed and justified. 
• Create a cost commission to set reasonable hospital reimbursement rates based on quality and outcomes. 
• Create a “public option” or a standardized plan to help drive down the cost of hospital and physician services. 
• Calculate marketplace premium tax credits based on the cost of a gold-level plan (80% actuarial level) instead of a silver-plan (70% actuarial level).

Expand access to affordable health coverage

• Make the premium assistance provided by the Inflation Reduction Act permanent, which has helped make healthcare more affordable for many entrepreneurs. 
• Encourage states to expand Medicaid that haven’t already done so. 
  • For those states that refuse to expand Medicaid eligibility, pass legislation to allow individuals in those states to purchase coverage through the Affordable Care Act (ACA) marketplace. 
• Expand health coverage options for immigrants, who are twice as likely to own a small business compared to those born in the United States. 
• Allow employees who are offered employer-sponsored insurance to receive premium assistance for marketplace coverage. This would eliminate the “unaffordability” threshold that consumers must currently meet to be eligible for the health premium assistance.
• Lower Medicare age criteria to include individuals ages 60 and older. This will in turn expand Medicare coverage, which is an important step toward closing the gap in healthcare access and is strongly supported by small businesses.
• Repeal regulations that expanded access to health plans that do not comply with the ACA, such as short-term plans and association health plans. 

Ensure essential benefits: Paid family leave, childcare and retirement

• Establish a national program that would provide partial wage replacement for small business owners, employees and the self-employed to access parental leave or to handle serious health conditions for themselves and family members. 
  • In the absence of a federal program, continue to establish state-run paid family and medical leave insurance programs. Paid family and medical leave programs should allow self-employed individuals to participate.
• Implement policies at the national and state level that would help more working parents afford childcare, understanding that this benefit is essential to retaining a skilled workforce. This could include expanding and improving income tax credits for childcare expenses and subsidies for childcare providers.
• Support state efforts to establish publicly-administered retirement savings ("Secure Choice") programs to help more small businesses and their employees access retirement plans. Additionally, allow self-employed entrepreneurs to access Secure Choice programs. 
• Enact additional policies to support small business employment and independent entrepreneurs. 
• Advance Clean Slate policies federally and in states to ensure that small businesses can tap into an underutilized workforce comprised of justice-impacted individuals who have remained crime-free for a period of time for non-sexual and non-violent crimes. 
• Create or expand state Earned Income Tax Credit (EITC) programs to increase small business employees' incomes. Ensure self-employed entrepreneurs are eligible to claim these credits.  

Promote commonsense and comprehensive immigration policies 

• Pass comprehensive immigration reform guaranteeing a path to citizenship for those who are essential for our continued economic success. 
• Find a long-term solution for recipients of Deferred Action for Child Arrivals (DACA), understanding that young immigrants are the lifeblood of entrepreneurship. Similarly, we must find a long-term solution for recipients of Temporary Protected Status (TPS).