NPR recently did a series of articles on the contracting/freelancing economy. This resonated with me, because, until recently, I relied on the “gig” economy to survive. After I graduated from UK with my master’s degree in 2014, I worked a number of temporary jobs. I taught a wide variety of college history courses on an “as needed” basis. The pay was low and I usually only taught at any one college for one or two semesters before I had to move on to the next position. I also wrote freelance magazine and newspaper articles. I enjoyed it, but the pay was irregular and low, even by industry standards. I also worked as a substitute teacher – another poorly paid, unreliable, and stressful job. On top of this, I didn’t receive any benefits from these myriad jobs. The only reason I was able to make ends meet was that I was living at home for most of the last four years. I couldn’t make enough money on a steady basis to afford living on my own.
Then I got sick. I was extremely fortunate that I was able to live at home and didn’t have a family for whom I had to provide. I didn’t have to try and make ends meet with irregular low-paying work while I was going through treatment. It would have been nearly impossible, since I couldn’t speak for about two months (a major problem for a teacher and journalist), and then my voice was very weak for at least another month after that. Plus, I was a huge jerk while I was on steroids.
Medicaid was the biggest benefit I received. It paid for the first nine months of my treatment, and, without it, my meager savings would have evaporated instantly. I was spared the added stress of dealing with mounting medical bills on top of everything else.
If I hadn’t had insurance, my whole upper-middle class family might have been financially ruined through no fault of their own. I had three surgeries in a single six-week period, and each cost several thousand dollars apiece. The CT scans were more than $1,000 each (I had four last year alone). The MRI scans cost thousands as well, and I had four of those too.
The biggest expense would have been my medication, which costs about as much as a house every year. Medicaid covered it all. So, my advice to anyone who gets sick is to first be very poor and qualify for Medicaid. It’s great that we have at least some basic safety net for people who are poor, but many people don’t qualify for Medicaid but can’t afford decent insurance either. My whole recovery would have been so much more difficult if I had to worry about skyrocketing medical bills and trying to take care of a family at the same time.
Eventually, once I got back on my feet, my income rose, and I lost my Medicaid coverage. I couldn’t find a permanent job with good benefits right away, so I relied on more temporary work and insurance from the Obamacare marketplace. This time, the work was steady, reliable, and well paid. It was project-based, so my job was relatively secure for the duration of the assignment. The pay was also about twice my highest previous salary. However, I didn’t have any PTO, insurance, or retirement benefits.
The Obamacare insurance was a good temporary solution, but it wasn’t a permanent fix. I still qualified for a subsidy, which reduced the monthly premium from about $300 to a more affordable $200. The benefits were pretty good – the deductible was a $1,000 and I met it almost instantly. However, at the end of 2017, the plan changed. The premiums went up to almost $500 (about $250 after my subsidy) and the deductible rose to $1,500. The out-of-pocket limit also increased, copays went up, etc. The insurance wasn’t as great as it had been, but it was still better than nothing.
However, the insurance didn’t cover my medication. Luckily, the manufacturer has a program that will help patients get access to their medication if they can’t afford it. For me, my income was still low enough that the foundation covered 100 percent of the cost. That generous assistance may eventually expire, but the foundation also offers co-pay assistance on a sliding scale. I’m lucky that the manufacturer put lives ahead of profits, but not all of them do.
So, a whole network of programs exists to help people who are very sick, including Medicaid, Obamacare, and private assistance programs. However, Trump has severely undermined Obamacare since he took office. He eliminated subsidies and the big tax cut also killed the individual mandate to buy insurance. Trump has authorized the sale of cut-rate plans and cut funding for the 2018 open enrollment period. Despite these setbacks, almost 9 million people signed up for Obamacare in the 2018 open enrollment period, exceeding expectations. Obviously, there is still a need and a desire for Obamacare. It’s not perfect but introducing instability and uncertainty hasn’t helped.
Recently, I found the Holy Grail of health insurance – the employer sponsored plan. I was hired for a permanent position by the same company with which I had been consulting. They offer a 401k, PTO, and several different health insurance options. Obviously, I picked the most comprehensive plan. The premiums are affordable, with a low deductible and reasonable copays. However, it still doesn’t cover my medication, and I rely on the corporate foundation to fill my prescription every month. Countless Americans are not so fortunate. Millions now rely on the gig economy and will face undue hardship if they ever get sick or hurt.
We should do everything we can to ensure that every person can get the healthcare they need. It’s a right, not a privilege. I can’t imagine how difficult it would have been trying to get through my treatment while also facing financial ruin. Illness, injury, or another disaster could strike any one of us (rick, poor, black, or white) at any time. It is basic compassion to ensure your neighbors of all classes and races have basic comfort and security. If the “gig” economy is here to stay, then we need a new sustainable system that offers health insurance, retirement, and other benefits. There are some models already, such as the Freelancer’s Union, which offers benefits; however, more should be done to ensure that nobody falls through the cracks. At the very least, professional programs, like the Freelancer’s Union, need to be improved and expanded. Adjunct professors are particularly vulnerable, although the Faculty Forward movement is trying to make improvements. New state and federal laws could also improve working conditions. I’ve been very fortunate, and I want to ensure all Americans have the assistance they need when facing major medical crises.