Inc.

RISING PROFITS EASIER MONEY HIGH ANXIETY

Sales are climbing and banks are (grudgingly) expanding credit. But entrepreneurs are getting queasy over health care costs. And the new administration and Congress? Oh, my
FOR THIS NEW GARMENTO, NOW’S THE TIME — Kristin Celano rolls a rack of her sports-team-inspired apparel in New York City’s garment district. After a decade as a tech executive, Celano could no longer delay her dream of becoming an entrepreneur and started women’s clothing company JaneHudson. The rate of women starting businesses rose in 2016.

GINGER Jones became an entrepreneur to care for others. Her $3 million business, Jones Therapy, based in Franklin, Tennessee, runs nine clinics for patients—mostly children—who struggle to speak, eat, or walk. So it pained her this year to curtail nonprofit sponsorships for the first time in the company’s seven-year history. She has also postponed technology investments and frets about the cost of adding an employee to expedite insurance approval for her expanding caseload of kids who need help.

In the past three years, Jones Therapy has grown 583 percent. Revenue-wise, “we are rocking and rolling,” says Jones. Yet the chaotic state of health care makes planning difficult. Insurance rates are rising, which leaves clients up the creek. Meanwhile, reimbursement for companies like Jones Therapy is declining by 1 to 3 percent annually. “The last two quarters have been really weird,” says Jones. “It’s the first time I have had uncertainty despite a growing business.”

Inc.’s annual report on the state of entrepreneurship finds many company owners grappling with similar cognitive dissonance. Sales and profits are up in 2016, and the economy—while not performing at the level of a Michael Phelps—is doing better than, say, a Missy Franklin. Yet entrepreneurs grew more dispirited about their prospects as the year progressed. The segment of small and midsize companies expecting to do substantially better in 2016 than in 2015 dropped from 40 percent in the first quarter to 29 percent in the third quarter, according to research from Dun & Bradstreet and Pepperdine University. In that same period, companies extremely confident they would grow at all fell from 50 to 42 percent.

A decline in confidence is often less a reflection of facts than a function of uncertainty. For health care companies like Jones’s, as well as employers seeking affordable coverage, a volatile insurance market proved unsettling. For other companies, the puzzlement was interest rates. Extreme weather. Brexit. A presidential race that the Twilight Zone’s Rod Serling might have narrated.

In surveys of optimism by the National

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