Writing Without a Net: How Repealing the ACA Will Hurt Freelancers

In the fall of 2015, I left my position as a grant writer for a literacy non-profit. I’ll be the first to tell you that I didn’t have much of a plan. Recoup from burnout, continue looking for a new job, travel to support my book of poems, write. That’s about as far into the future as I could see.

I packed up my apartment in Boston and drove a moving truck eight hours in the rain, back to the hometown in rural Pennsylvania that I worked so hard to escape.

When I think of my decision to return here, I feel all the attendant shame of moving home after ten years of fierce independence—but I also feel incandescently lucky. I could only step off the cliff because my family was there to save me.

While I job-hunted with a borrowed Brooklyn address, I started freelancing. Soon enough I was navigating both copywriting and journalism, and eventually I stopped looking for other jobs—interviewing in cities meant spending hours in the car when I was making a decent salary in front of my computer at home. I purchased an insurance plan through HealthCare.gov, proud to consider myself a small business owner in the tradition of my father and my grandfather.

Now, like many of the other freelancers in our industry, I’m standing at the lip of a different cliff. This time I’m not jumping by choice. Republicans in Congress, empowered by our new president, are working hand over fist to push me—and millions of other Americans—off the edge.

Despite reservations from both sides of the aisle and mass protests against repeal of the legislation, the new President signed an executive order on his first day in office instructing his administration to “minimize the unwarranted economic and regulatory burdens of the [Affordable Care] Act.”

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One week before the Senate first started the process of rolling back the ACA during budget debates, Medium announced it was cutting 50 jobs, and writers in my Twitter feed mourned dwindling books coverage in The Boston Globe and elsewhere.

By now, writers—especially critics—are used to these kinds of announcements. For a decade, we’ve watched arts coverage at major newspapers and magazines trickle to almost nothing. It almost feels normal to hear another outlet is on the chopping block, though it doesn’t come as any less of a blow.

But since 2010, the ACA had been making it easier to navigate the murky waters of life as an independent contractor in a shrinking industry. Sometimes the role of independent contractor is one that writers—like me—take on more or less willingly. For others, it comes out of the permanent loss of a good full-time job or the need to hustle for extra cash outside of a teaching position or part-time gig.

When I spoke with Manjula Martin, editor of the anthology Scratch: Writers, Money, & the Art of Making a Living and co-founder of the website Who Pays Writers, she was quick to point out that even full-time writers with staff jobs or book contracts struggle with job security and scope creep.

“It’s interesting to think about a work environment in this country where people don’t have any of the benefits of being an employee, while, at the same time, work as a presence has grown in our lives,” said Martin, who, after many years as a freelance writer and editor, took a full-time position at Zoetrope: All Story.

“We’re always checking our email, we’re always checking our phone, we’re always looking for the next thing.”

The result, she says, is that employers can come to view their workforce as disposable, while the increased risks associated with freelancing make it harder for people to make the jump—or sustain their careers once they do.

“The type of risks that are necessary to take as a self-employed person or as a creative person—or both—become much more difficult to take if we have absolutely zero safety net,” Martin said of the effects a potential repeal of the ACA might have on creative professionals who freelance.

She’s right. Republicans and Democrats alike ignore at their own peril that the fate of small business economies across America—including the freelance economy—largely depends on the ACA.

According to a report from the Department of Health and Human Services released in late January, “one in five 2014 Marketplace consumers was a small business owner or self-employed”: that’s about 1.4 million people. (As of Tuesday, January 24th, the HHS’s explanation of this report was mysteriously removed from their website. The full report, from the Department of Treasury, can be found here.)

Of course, the ACA does more than insure self-employed independent contractors: It also lays out clear protective provisions for those with pre-existing conditions. In the insurance industry, a pre-existing condition can run the gamut from anxiety to cancer to being born with an X-chromosome or identifying as transgender.

Ted Weinstein, who owns the San Francisco-based agency Ted Weinstein Literary Management, told me that as little as a decades-old surgery had landed him on a pre-existing conditions list that prevented him from seeking out a more affordable health plan.

“At one point, I tried to switch to Blue Cross/Blue Shield,” explained Weinstein, “and because I’d had knee surgery 25 years earlier, they refused to grant me coverage for anything.” Weinstein had to stick with his original insurer, despite rising premium costs.

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For Lorraine Berry, a former professor at SUNY-Cortland who now runs a small writing business with her partner in Florida, the ACA is all that stands between her and a second medical bankruptcy.

“People don’t realize how easy it is to find yourself in a medical bankruptcy situation,” said Berry, who writes about books for The Guardian and this outlet.

In 1997, Berry underwent spinal surgery that, after complications and physical therapy, left her with $300,000 in medical debt. Now, she requires medication for chronic daily migraines, an unintended result of the operation. Just one of the medications Berry takes to function, Relpax, can cost as much as $600 per month out of pocket.

Ultimately, Berry fears that the repeal of the ACA will force her and her partner to fold their business, since the couple cannot afford steep increases in premiums or paying out of pocket for medical care.

Like Berry, veteran journalist Jen A. Miller is considering what the repeal of the ACA could do to her business.

“I don’t want to give up my writing career because of health insurance,” said Miller, who may even move to Canada, where she has long-time friends. “I just believe in what I do too much.”

Prior to the ACA, as Miller reminded me, you could also be charged higher premiums on the private insurance market just for being a cisgender woman (i.e. possessing that baby-making ticking time-bomb called a uterus).

“When the Affordable Care Act was passed by the Supreme Court, I was on the beach,” said Miller, who lives and works in New Jersey. “I saw that President Obama said being a woman is no longer a pre-existing condition, and I cried.”

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For some writers with disabilities, however, the ACA hasn’t necessarily made a huge impact.

A well-established sports journalist based in Colorado, Joe Lindsey suffers from hearing loss, a disability rarely covered by insurance policies. (Hearing aids can cost up to $6,000 every three years, he says.)

According to Lindsey, rising premiums on the private market, even pre-ACA, eventually made the generous group insurance policy offered by his wife’s employer too tempting to resist. “Before the ACA passed, and certainly before it was implemented, I ended up ratcheting my plan to less coverage with a higher deductible, as an attempt to keep premium increases affordable,” said Lindsey. “I did that three or four times.”

Now, his wife’s insurance plan offers better coverage for less money—and kicks in a little toward the cost of his hearing aids, too.

Novelist Porochista Khakpour, author of the forthcoming memoir Sick and a writer-in-residence at Bard College, suffers from late-stage Lyme disease, which profoundly affects her ability to work.

“I’ve had to not work at times and be at the mercy of donations from friends,” Khakpour explained by email. “I’ve even moved back to my parents’ home.”

While her current health plan, offered through Bard, doesn’t cover treatments for Lyme disease, it does help Khakpour with complications from the condition. “For instance, I have dysautonomia [a malfunction of the nervous system] from Lyme and complications from that might require I be under observation at a hospital,” she wrote.

Still, Khakpour feels grateful for the ACA and depended on the legislation for access to healthcare when she wasn’t teaching.

“The ACA had all sorts of little problems, but my general feeling is it was wonderful and truly saved my life,” Khakpour wrote. “It gave me the opportunity to live like so many Americans—to know I can receive care in the event of an emergency.”

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At a January 12th Town Hall televised by CNN, Speaker Paul Ryan told a cancer survivor that people with “that kind of pre-existing condition” would still have access to care through state high-risk pools. What Ryan failed to mention was that high-risk pools only work when they’re extremely well-funded, as one Kaiser Family Foundation analysis points out.

Last October, Republicans in Congress blocked payments to insurance companies for offsetting the “risk corridor,” that is, the cost of insuring more “high-risk” (high-cost) patients. Who’s to say they won’t do it again? Without adequate funding and premium caps state high-risk pools could easily push poorer patients closer to death or medical bankruptcy as the wait for treatment—and high costs—run out the clock.

So far, storytelling campaigns aimed at moving the GOP have largely fallen on deaf ears. Representatives have even been caught dodging constituents at town hall meetings (we see you, Congressman Mike Coffman of Colorado!) or barring large gatherings from their offices (a hearty shout-out to my own Pennsylvania rep, Senator Pat Toomey).

But even if we wind up losing the battle for affordable healthcare to the GOP, we now have a place to start from, Martin assured me.

“The really powerful thing about the Affordable Care Act is that it made people realize we should have something better,” she suggested.

“Prior to the ACA, people didn’t expect any kind of coverage. Now people expect basic coverage.”

For the first time, I’m hearing friends and family members asking questions like, “Why should my health insurance be tied to my place of employment?” and “Why do I have to be married to have good healthcare?”

The old answers for these questions, the pre-ACA answers, are no longer good enough.

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As much as I worry about concrete things, like being able to afford my premiums in the future, or getting kicked off a plan that helps me pay for birth control and hypothyroidism, I also worry in the abstract about the profession I love.

What will happen to writing in our country when writers already at the margins have even bigger walls to scale? When the loss of protections provided by the ACA make the financial burden of hustling for bylines too great to bear?

The loss of social safety nets for lower- and middle-class writers of all genders, ethnicities, and backgrounds will increasingly make our industry accessible only to those who have economic and educational clout.

And despite endless AWP panels about diversity, racial and class barriers to entry in this profession are alive and well. The Diversity Baseline Survey published by Lee & Low in 2015 says a lot: book publishing’s employees are overwhelmingly white, and few people of color hold leadership positions. In a similar vein, the VIDA count reminds us of the entrenched racial and gender disparity in literary magazines and book reviews.

We need more to offset these systemic problems, but the social and economic climate created by the new President doesn’t make me feel hopeful that change is on the way. Fellowships like those offered by BuzzFeed for Emerging Writers are few and far between; they arise out of great need and are successful only with deep institutional commitment, which can be difficult to muster under the best of circumstances. Internships at major publishers still only provide a nominal fee—or nothing at all. Student loan repayment programs for employees, like the one now offered by Penguin Random House, are unusual enough to warrant a press campaign.

Even as the media and publishing industries struggle to shift course and accommodate racial, economic, and gender diversity, they appear in danger of slipping backward. And they might not catch up at all if anti-progressive legislation widens the gap.

“Dismantling the ACA means a wealth of diverse talent will cease to exist across all creative disciplines,” writer Rahawa Haile suggested via email.

“And yes, there will always be someone to step in, but we are talking about barriers to opportunity that will specifically target vulnerable and historically disenfranchised populations,” she added.

Haile, who freelanced on-and-off prior to her epic hike of the Appalachian Trail last year, just committed herself to writing full-time this past November.

“Go figure,” she quipped of the timing.

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In many ways, our current situation is one of perilous realities of writing during late capitalism. Major companies will continue to restructure and ditch full-time jobs as the freelance economy grows.

“Often conversations about workplace benefits come down to cost and profit,” Martin told me. “And human beings are not profit models.”

You can find the moral argument against profit-motive for services like health care in other fields, too, from education to art. But, even if the ongoing devaluation of writing and creative labor is demoralizing to watch, writing for money is still the exchange that powers our industry. It’s fundamentally more difficult for freelancers to navigate this terrain as social safety nets disappear—particularly those for whom the stakes are already so high.

The Affordable Care Act helped make this process survivable, if not always livable. What exactly this will mean for the future of publishing and media remains unclear, but one thing is for certain: if the ACA is gutted without a replacement, tens of thousands will die and many more will suffer, unnecessarily, from ill health. Human beings may not be a profit model for the Republican Congress to exploit, but, as recent protests and a deluge of phone calls, emails, and lobbying efforts demonstrate, we can be a powerful force of opposition to injustice. I’m hoping this is a cliff our lawmakers will ultimately back away from. It’s up to all of us to make sure they do.