Throughout my career as a nonprofit communications professional and small business owner, I’ve had something in common with athletes: When I get hurt, I have to walk it off. For more than 30 years, I was health insurance insecure. Occasionally, I had health benefits through full-time jobs, but mostly I relied on a patchwork of COBRA coverage or parental assistance. Often, I avoided seeking care entirely. The result is that I never felt comfortable or safe. I used to wonder, “What if I have an accident?” And even when I did have insurance, I would think about what would happen if I lost my benefits. These questions alone took a toll on my mental health.
In 2013, I could finally feel safe. Thanks to the Affordable Care Act, or ACA, I was able to purchase quality, affordable health insurance. In those first few years, my coverage costs increased slightly, but not so much that I had to drop coverage. The ACA has been a game-changer for self-employed people like me and for small business owners generally. In 2022, 3.3 million small business owners and self-employed entrepreneurs were covered by the Marketplace, compared with just 2.6 million one year earlier. The ACA is a growing and vital program.
The importance of the ACA, however, goes far beyond statistics. In fact, the ACA likely saved my life. About a decade ago, I had a long-lasting cold and was prescribed antibiotics. I developed a delayed intolerance to the medication that turned into anaphylaxis. My throat started to swell shut, and so did my eyes, so I walked myself to the hospital since I couldn’t see to drive. I likely would not have gone to the ER if I didn’t have insurance and might have died.
The following year, my chronic back pain worsened until I could barely sit or walk. I was in agony for nine months until I had several spine surgeries to repair a serious slipped disk. Because I had ACA insurance, my costs were about $8,000 instead of hundreds of thousands of dollars, which would have bankrupted me.
Today, my ACA plan costs about $590 per month. That cost would be even higher if I did not receive a tax credit, known as the enhanced premium tax credit, or EPTC, which is calculated based on income level through the ACA Marketplace. This subsidy is critical to small business owners like me, even though with that assistance, I am unable to afford a comprehensive plan for all my needs.
Once again, I fear that insurance coverage will become unaffordable because Congress has not yet renewed the EPTC, which is set to expire at the end of 2025. Without that credit, my monthly cost would increase by about $100, so I will have to seriously consider downgrading my coverage or dropping it altogether. I am not alone: Eighty-two percent of small business owners and self-employed entrepreneurs enrolled in the ACA Marketplace in 2022 claimed the EPTC.
Without the EPTC, I might have to abandon freelancing just to take a job with health care. But in the land of the free, Americans shouldn’t be constrained by “golden handcuffs,” and no one should be locked into a job to access a necessity like health insurance. For the benefit of millions of small business owners and freelancers nationwide, Congress must immediately extend the EPTC before it’s too late for a whole segment of our economy.