In his letter, addressed to the Chief Counsel for Advocacy, Winslow Sargent, Graves outlines the steep rise of occupations subject to state and local licensure laws, which now directly affects about one in three occupations and creates barriers for entrepreneurs. According to a 2007 study, the total cost of licensing regulations to the economy is between $34.8 billion to $41.7 billion per year. Notably, a June 2014 study found that occupational licensing was the number one regulatory burden facing small firms. In an economy in which jobs are still scarce, these requirements can reduce opportunities and create unnecessary obstacles for individuals, especially those of fewer means, who want to start a business and attain economic self-sufficiency.
“At a time of economic uncertainty, when our nation’s job creators, small businesses, are struggling to stay afloat, we are concerned that occupational licensing laws which are not narrowly tailored to the public benefit could have the unintended consequence of stifling entrepreneurship,” Graves states in the letter. “Occupational licensing also may impede innovation and business development as would-be entrepreneurs focus their resources on meeting licensing board requirements rather than on meeting the needs of their businesses or customers.”
The Committee on Small Business has closely monitored this issue and as the letter states, “The Committee on Small Business has held two hearings over the past few months regarding the barriers to entrepreneurship caused by occupational licensing and we believe that this issue merits further examination. At a Subcommittee on Contracting and Workforce of the Committee on Small Business hearing on March 26, 2014, entrepreneurs and academic experts testified on the barriers to entry that such anti-competitive licensing places on entering the market and job creation. At a July 16, 2014, Committee on Small Business hearing the Federal Trade Commission (FTC) testified on its efforts to curb anti-competitive licensing schemes through advocacy and enforcement of federal anti-trust laws to prohibit unfair competition.”
The entire letter to the Office of Advocacy is available HERE.### Read More
We recently celebrated "Start-up Day Across America," a day to celebrate the importance of entrepreneurship and raise awareness about the job-creating potential of start-ups. We know that small businesses create the bulk of net new jobs in this country, but interestingly enough, research has shown that it is a particular subset of small firms — start-ups — that are actually leading the way in job creation. According to the Kauffman Foundation, a small 1 percent of start-up firms account for 10 percent of new jobs each year. Further, a report by the Pacific Research Institute estimates that in a given year, each net job created by start-up firms increases a state's gross product by almost $1.2 million; shedding light on the significant benefits growing start-ups can have on the local economy. With numbers like these, it is easy to see why Americans are beginning to focus on the importance of start-ups.
Start-ups are rapidly moving and as we all know, the government is not. So when the Small Business Committee holds hearings and listens to the real-life challenges of start-ups, we learn what we can do, or usually not do, to allow them to stimulate the economy, create jobs, and spur innovation. Frequently, the story goes that government intrusion into this space only slows down start-ups and makes things harder; even when the government's actions are best intentioned.
Take, for example, crowdfunding — it's been one step forward, with many steps back. Access to capital is an important issue, especially for companies just starting out, where a month or two of funding can change everything. While Congress passed the Jumpstart Our Business Startups Act of 2012 (JOBS Act) over two years ago, many of the relevant crowdfunding regulations are yet to be released, and the regulations that have been proposed seem to set up more roadblocks to obtaining capital than providing access to financing. The bill's supporters saw it as an opportunity to allow start-ups to thrive, not create even more onerous regulations. Unfortunately, some in Washington have mastered snatching defeat from the jaws of victory.
That said, start-ups have mentioned a few things Congress can do to help — one is finding ways to combat patent trolls. Patent trolls are entities or people that attempt to bring frivolous patent claims against all types of businesses to challenge or try to take intellectual property. For start-ups, their intellectual property may be the most valuable asset they have. The cost of patent litigation is particularly harmful to entrepreneurs because they take limited resources away from building that next great product or service.
How can we expect to get the economy back on track and create meaningful employment when start-ups are afraid to innovate and create new products due to the potential threat of an all-too-often meritless demand letter from a patent troll that could shut the company down and turn away investors?
In December, the House overwhelmingly passed H.R. 3309, The Innovation Act, with strong bipartisan support to begin addressing patent trolls. While this legislation lacked a provision specifically addressing demand letters, it was a step in the right direction to prevent costly litigation and add much needed transparency. Yet, Senate Majority Leader Harry Reid has not brought the bill up for a vote in the Senate; refusing to truly create better conditions for these important companies. To me this is inexcusable.
As we think about the economy, it is time to start thinking about start-ups as an integral piece of the puzzle. Start-ups are not just a hip new term or a group of companies isolated to one part of the country. They are in each and every one of our backyards actively working to revive America's economy and make a living for themselves.
Commentary by Sam Graves (R-Mo.), chairman of the U.S. House of Representatives' Small Business Committee and U.S. representative of the 6th congressional district of Missouri. Graves, who is a sixth generation family farmer, has served in Congress since 2001. Follow the committee on Twitter @SmallBizGOP.
Read the article online HERE.Read More
House Small Business Committee Chairman Sam Graves (R-MO) today released the following statement on the release of the Small Business Administration (SBA) FY 2013 Small Business Contracting Scorecard, showing that for the first time since 2005, the federal government reached the government-wide 23 percent goal for small business contracting:
“For the first time in eight years, the federal government has finally met its 23 percent goal for small business contracts. This demonstrates that the reforms enacted during the past 2 Congresses are working. We've focused on helping small businesses compete for federal contracts by including small business goals in senior agency employee performance reviews and bonus discussions, increasing the authority of the small business contracting advocates, and making the size regulations easier to follow. Once SBA implements the rest of these reforms, such as making it easier for small companies to team on larger contracts or find mentors, small business participation will continue to rise. Now that the small business contracting goal has been met, we should not relax in helping more small businesses compete; the Senate should follow the House in raising the small business goal to 25 percent, to help more small businesses grow and create jobs.
POLITICO eHealth: Broadband: The other big obstacle to telemedicine
By David Pittman
July 31, 2014
A lack of good Internet connections is nearly as big an obstacle to increasing telemedicine as the lack of Medicare funding for the services, witnesses told a congressional hearing Thursday.
Many hospitals and doctors’ offices across the country lack broadband or fiber-optic cabling with the necessary bandwidth to use certain forms of telemedicine, said Maggie Basgall of Lenora, Kan.’s Nex-Tech, a broadband-service provider for rural areas in the upper Midwest. Many patients lack wireless capabilities and are still reliant on dial-up Internet.
“Without that, they can’t do in-home telemedicine,” Basgall said following a House Small Business Health and Technology Subcommittee hearing.
Although there are 46 telemedicine-related bills pending before Congress, the hearing was just the second devoted to the issue this year. A bill is expected to be brought to the floor in 2015.
“What our purpose was today, and I think we’ve done it, was to start a discussion,” said Rep. Chris Collins, chairman of the subcommittee. “If we don’t start the discussion at some point, we’re seeing a hodge-podge of things move forward, state by state.”
Rep. Blaine Luetkemeyer (R-Mo.) said the lack of broadband was the biggest impediment to telemedicine after the lack of federal reimbursement.
“I live in a rural part of Missouri, and I’m barely in a broadband area myself,” Luetkemeyer said. “I know that there are a lot of areas within my own district that may not have broadband.”
Basgall singled out for blame the FCC’s quantile regression analysis, which changed the ways its $4.5 billion Universal Service Fund program doled out support to small telecommunications providers.
Rural broadband providers like Nex-Tech felt they could no longer reliably predict if they would be able to recover the costs of network upgrades and therefore stopped seeking loans to build faster networks, she said.
The FCC scrapped the changes earlier this year and is considering a replacement.
“I think [the FCC] realized it wasn’t predictable,” Basgall said. “People can’t build infrastructure when they’re trying to follow a model that doesn’t give them predictable support.”
Karen Rheuban, director of the University of Virginia’s Center for Telehealth, said the FCC’s Rural Health Care Program, which provides discounts to rural providers seeking broadband, has gone unfulfilled because of its “onerous, complex application process, and statutory exclusions to eligibility that do not always align with health disparities.”
Broadband wasn’t the only topic during Thursday’s hearing. Witnesses spoke about Medicare’s restrictive reimbursement policies, which are limited to live, face-to-face interactions delivered from health care facilities located outside of metropolitan areas. As a result, Medicare paid a mere $12 million for telemedicine services last year.
“Common sense says we need to move this forward,” Collins said. “If a doctor doesn’t get paid, they’re not going to participate.”
Rheuban also mentioned a cumbersome licensure model for providers who wish to treat patients in other states. Anti-kickback laws limit physicians from making referrals to places where they own an interest, such as telemedicine equipment they provided for another’s use.
Patient privacy laws and bureaucratic informed consent procedures are also barriers, Rheuban said.
Read the story here: https://www.politicopro.com/story/ehealth/?id=36957Read More
E&E News: In final House appearance, Perciasepe spars with Republicans over waters rule, trust issues
By Amanda Peterka, E&E Reporter
July 31, 2014
The House Small Business Committee yesterday sent departing U.S. EPA Deputy Administrator Bob Perciasepe off with a contentious hearing over agency regulations.
Throughout the hearing, House lawmakers sparred over the agency's recent proposal to define which waters of the United States are included under the jurisdiction of the Clean Water Act. They jumped on comments by Perciasepe that the rule would not have a direct impact on small businesses or expand the scope of EPA's authority under the Clean Water Act.
It was Perciasepe's last time in the congressional hot seat before he leaves EPA in a couple of weeks to head a climate change group. Although Perciasepe did not give an inch in defending the waters rule, he expressed a desire for the agency to work more with Congress.
"I'm trying to explain what our intent is and trying to build a bridge," he said.
But Republican members of the committee said there were deep trust issues impeding cooperation.
"Nobody trusts the EPA," Rep. Chris Collins (R-N.Y.) said.
Perciasepe, who has been the agency's longest-serving deputy administrator, will take the helm of the Center for Climate and Energy Solutions on Aug. 11, succeeding Eileen Claussen. EPA announced his departure two weeks ago.
During his time as deputy administrator, Perciasepe has taken the brunt of congressional furor over agency rulemakings, appearing as the agency's representative at numerous hearings.
Though yesterday's hearing touched at times on EPA's long-awaited rules for reducing carbon dioxide emissions at power plants, talk of the waters rule dominated the hearing. The proposed rule released earlier this year seeks to clarify which streams and wetlands receive automatic protection under the Clean Water Act.
Farmers have lashed out at the proposal, calling it a federal power grab and raising concerns that they would be required to obtain permits for everyday farming activities.
Perciasepe sought to quell some of those concerns, saying that the rule that merely defines where other parts of the Clean Water Act will apply.
"If you have a permit now, you have to get a permit under this. But if you don't have to get a permit now, it's most likely you would not need a permit under this," he said.
But House Small Business Chairman Sam Graves (R-Mo.) said that before issuing the rule, the agency should have gone through the Regulatory Flexibility Act, a law that requires an agency to convene small-business review panels to determine potential impacts.
"I think a lot of these concerns may have been identified if the EPA had complied with the RFA," he said.
Perciasepe said EPA determined that the rule would not have direct impacts on small businesses.
"It doesn't directly impose any requirements on anybody if they're not discharging pollutants," he said. "So it doesn't directly impact large businesses or small businesses in any way."
But those comments drew some scorn and disbelief from Republican members of the committee. Not going through that review process is "either extremely naïve and incompetent, or it's arrogance to the highest degree," said Rep. Blaine Luetkemeyer (R-Mo.).
Even ranking member Nydia Velazquez (D-N.Y.) said she was concerned that EPA hadn't more fully examined the rule's impact on small businesses.
"I just do not understand how do you come to the conclusion that there is not direct impact on small entities, because you haven't provided us the process in which you arrived to that conclusion," she said.
But Velazquez distanced herself from statements made at the hearing that Congress -- both Republicans and Democrats -- do not trust the agency and believe it should completely start over with the waters rule.
Perciasepe also said he doesn't believe "that most people don't trust EPA" and dismissed the idea of withdrawing the rule. Congress, he said, has put the agency in a difficult position in light of Supreme Court directions that the agency clarify the scope of its authority over waters in the United States.
"I have a Supreme Court chief who's saying, 'Why don't the agencies do this?'" Perciasepe said. "There are three branches of government. I have one branch [the legislative] who wrote to me when I was acting administrator saying please do a rulemaking. Now I have that branch saying maybe we should withdraw it."
But those comments led one lawmaker, Rep. Richard Hanna (R-N.Y.), to accuse Perciasepe of falling back on the Supreme Court and not taking responsibility for EPA's actions. Perciasepe was "not going anywhere" with his testimony if the goal was increasing the trust between EPA and Congress, he said.
Members of the committee only briefly acknowledged Perciasepe's impending departure.
"I got to give you a lot of credit," Collins said. "I think you knew you were coming into the lion's den today, and here you are. It's hard to defend the indefensible, and that's what your agency has sent you to do."
CQ: Growth of Telehealth May Hinge on Government Commitment
By Kerry Young, CQ HealthBeat Associate Editor
July 31, 2014
Doctors, researchers and officials at companies such as Humana Inc. are tinkering with ideas for expanding the use of remote medical visits and services, but the true driver for expansion of telehealth likely will be the nation’s biggest purchaser of health care.
For now, the Centers for Medicare and Medicaid Services is taking a “rather cautious” approach in its payment policies for remote services and monitoring, Megan McHugh, a health researcher from Northwestern University, told a House panel Thursday.
That’s justified given that the evidence for benefits has not been conclusive, she said. Remote medical consultation and monitoring have been hailed by many advocates as potential game-changers that could cut costs and help people better manage chronic illnesses, such as diabetes.
Yet, studies so far have drawn opposing conclusions about the benefits, McHugh said. She cited a compilation of 20 reviews that found telemedicine effective, while 22 others found it to be of limited benefit or ineffective. Another 19 were less confident of the benefits, but did note its potential.
“The gradual expansion of telemedicine coverage under Medicare is a sensible course of action and one that will produce a slow but steady increase in the number of small practices that effectively and efficiently use telemedicine,” McHugh told the House Small Business Committee’s panel on health and technology.
Medicare’s decisions ripple beyond even the pool of roughly 50 million people covered by the program for the elderly and disabled. They are “magnified” because insurance companies often look to CMS decisions in setting their own policies, McHugh said. Through its rulemaking process, CMS has expanded somewhat the field of doctors and patients for which it will pay for telehealth, she said.
For 2014, CMS has somewhat widened the geographic limits that had been earlier written to restrict payments for the services to cases where people faced long trips to see a doctor. By allowing telemedicine payments for some parts of the metropolitan statistical areas, CMS has made services reimbursable for about 1 million more people enrolled in Medicare.
There’s clearly a drive among some lawmakers to get CMS to take a more expansive approach, even as small-scale experiments take place around the country that may make clear both the advantages and shortcomings of the technology.
Sen. Thad Cochran, R-Miss., this month introduced a bill (S 2662) that’s intended to waive certain Medicare restrictions on telehealth. It’s a companion measure to a bill (HR 3306) from Rep. Gregg Harper, R-Miss., which has about 20 cosponsors. The American Telehealth Association, which includes companies such as Humana and Dutch technology company Philips, supports the measure.
Smaller-scale efforts underway include a Humana program intended to help elderly people remain in their homes longer by protecting against falls and other health threats.
Humana in December said about 100 people in its Medicare Advantage programs had enrolled in the pilot program intended to use remote monitoring to help frail elderly people continue living in their own homes. The project involves in-home sensors and remote monitoring that will report changes in normal patterns of movement to Humana care managers. The sensors will check on daily activities such as sleeping and eating. Changes in patterns for these activities can be early warning signs of illness, and detecting them may allow Humana workers to step in earlier to offer aid, the company said.
In testimony for the Thursday hearing, McHugh said that dermatologists at Kaiser Permanente in San Diego were able to handle 50 percent more cases through a remote teleheath system, in which patients’ history and images of skin lesions were made available to them, than they would have been able to handle in face-to-face visits.
The question of licensing across states for telehealth services also arose at the hearing. Chris Collins, R-N.Y., the chairman of House Small Business’ health and technology panel, asked whether some exceptions to federal rules might be needed to allow doctors to get reimbursed for seeing their own patients via telehealth when they are far from home.
"I am from western New York and we have a lot of folks in our older population who go south for three months to Florida,” he said. “It’s not a New York doctor poaching in the Florida area for clients but an existing client relationship."
Find the article here: http://www.cq.com/doc/hbnews-4529069?9&search=PpviGoxU
“Over the past few years, there has been a lot of debate about reforming America’s health care system,” said Chairman Collins. “One of the best ways to reform health care and reduce costs is to allow the private sector to improve the industry through innovation and increased access. Telemedicine is the type of tool that does this, and we should fully embrace it. Some physicians and telemedicine advocates are concerned that regulatory barriers will keep this cost-saving and useful technology from reaching its full potential. Washington must work with the medical community to make sure technological advances, like telemedicine, are able to thrive so that they improve the quality and affordability of care.”
Materials from the hearing are available on the Committee’s website HERE.
Dr. Karen Rheuban, Senior Associate Dean for CME and External Affairs Director at the University of Virginia Center for Telehealth in Charlottesville, VA said, “Telehealth is an essential tool to address the significant challenges of access to high quality care for both acute and chronic disease management, to mitigate workforce shortages, improve population health and lower cost of care. There are many opportunities for small practices to integrate telehealth models into every-day practice. However, even for large healthcare systems, managing and navigating the complex legal and regulatory environment which impacts the practice of healthcare using telehealth tools can be challenging. For small group practices and solo practitioners, telehealth holds great promise, but the administrative and regulatory challenges can be overwhelming. Thus it is imperative that we create and promulgate policies that foster certainty, transparency, high quality, secure and sustainable solutions that empower patients, providers and payers to adopt 21st Century models of care.”
Dr. Brenda Dintiman, FAAD at Fair Oaks Skin Care Center in Fairfax, VA said, “I have faced several barriers to most effectively providing care via telemedicine. While I face these barriers as a physician, it is ultimately the patients – often the most economically vulnerable – that are the most directly affected. The largest barrier as noted is reimbursement for telehealth services. Without assured reimbursement, providers and patients are unlikely to utilize telehealth. While Virginia law addresses coverage for telehealth services, this does not guarantee access with all private insurance and many states do not have similar policies.”
Ms. Maggie Basgall, Community Development Specialist for Nex-Tech in Lenora, KS said,“Telemedicine already offers health care providers numerous ways to better serve patients, and many more exciting innovations are on the horizon. The desire for advanced telemedicine already exists, but now we must supply – and then sustain – the robust broadband capability, funding, and education to spur increased adoption of the services across the country.”
The Committee examined the EPA’s failure to assess the economic impacts of both the recently issued “waters of the United States” proposed rule and the proposed rules to reduce greenhouse gas (GHG) emissions from power plants on small businesses. Under the Regulatory Flexibility Act (RFA), the EPA must thoroughly assess how these rules would impact small businesses and consider ways to reduce the rules’ negative consequences. It must also conduct outreach to small businesses before the rules are proposed to get direct input from small businesses. EPA Deputy Administrator Bob Perciasepe testified.
“The EPA’s power grab goes beyond the agency’s mission and infringes on the rights of individuals and small business owners, and it will potentially have costly economic consequences,” said Chairman Graves. “The EPA must withdraw the costly ‘waters’ rule, and reevaluate these decisions entirely. Congress passed the RFA precisely to protect small businesses from this kind of regulatory overreach. The EPA fell far short of its obligations, and must do more to ensure small businesses do not bear the brunt of a regulatory burden that was not properly assessed. The Committee has alerted small businesses and raised serious objections to these rules, and I urge the EPA to fulfill its responsibilities to small businesses. Assessing the impacts of regulations on small businesses is not a choice, it’s an obligation and the EPA must comply with the law.”
Materials from the hearing are available on the Committee’s website HERE.### Read More
Bloomberg BNA: EPA Has Lost Credibility With Land Owners, Small Business Committee Republicans Say
By Dean Scott
July 30, 2014
House Small Business Committee Republicans told a top Environmental Protection Agency official July 30 that the agency has lost credibility with farmers, land owners and small businesses over an April proposal they fear would expand EPA jurisdiction of the Clean Water Act to farm ditches and other minor streams.
EPA Deputy Administrator Bob Perciasepe sought to allay what he said were misconceptions about the proposed waters of the U.S. rule, which the EPA and the U.S. Army Corps of Engineers unveiled in March and published April 21 (79 Fed. Reg. 22,187).
The joint proposal would bring under federal jurisdiction all tributaries of streams, lakes, ponds and impoundments as well as wetlands that affect the chemical, physical and biological integrity of navigable downstream waters (77 DER A-13, 4/22/14).
Perciasepe said the rule, which would clarify the Clean Water Act's jurisdiction over the nation's waters and wetlands, would only apply to waterways that have a significant “nexus” in affecting downstream navigable waters. He said the agency makes every effort to seek input on its regulatory proposals and that the regulations generally would not cover minor waterways, such as roadside ditches, as long as they don't affect water quality of larger waterways downstream.
Unwarranted Expansion of Jurisdiction?
But Republicans, including Reps. Chris Collins (N.Y.) and Scott Tipton (Colo.), said the EPA has grown tone deaf to concerns that it has overreached with its regulatory agenda under President Barack Obama.
“The farmers don't trust you, land owners don't trust you, and the public doesn't trust you,” Collins said.
Republicans said the agency's Clean Water Act jurisdiction rulemaking is an unwarranted expansion of EPA jurisdiction and fear the regulations could require permitting of roadside and farm ditches, groundwater seepage and other minor waters. Republicans on the panel pressed Perciasepe to ensure the agency applies more broadly Regulatory Flexibility Act provisions that require the EPA to seek input from small businesses on its rulemakings.
Committee Chairman Sam Graves (R-Mo.) said he had to push the agency repeatedly over the last year to get an EPA official to testify before the panel on how its rules affect small businesses. EPA's recent rulemakings “are an unprecedented power grab that are infringing on the rights of both the individual and small business owner,” Graves said.
Perciasepe, a longtime EPA employee, is leaving his post as deputy EPA administrator in August to head the Center for Climate and Energy Solutions (C2ES), formerly the Pew Center on Global Climate Change. He will succeed another former high-level EPA official, Eileen Claussen (138 DEN A-2, 7/18/14)(138 DER A-17, 7/18/14).
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