Filling the gap in healthcare coverage : how cities and states can bolster health insurance affordability for independent workers and small employers

The nature of work is changing in the United States. The emergence of the gig economy and the rise of knowledge work have created new opportunities and challenges for workers. While flexibility has increased over the past decade, with more individuals working when and where they want, wages have remained stagnant and employee benefits — often associated with traditional attachments to work — have moved further out of reach for many working adults. Affording quality health insurance on the individual and small group markets is a major financial burden for independent workers and small employers (companies with 50 or fewer employees). Ideally, federal legislation would be adopted to ensure that the US healthcare policy regime meets the needs of working Americans. Indeed, the passage of the Patient Protection and Affordable Care Act (ACA) of 2010 moved the country closer to such a solution. But the bill was not a panacea. Many consumers earn too much to enroll Medicaid or receive subsidies through the ACA, but not enough to afford quality health insurance on their own. And experts believe recent regulatory action will add to this hardship by raising rates in the individual and small group markets. Cities and states, nevertheless, are well positioned to make quality healthcare coverage more affordable for their residents. These governments also have a lot to gain by acting, as expanding quality health insurance to more independent workers and small employers is linked to enhanced job creation, workforce productivity, and innovation intensity. Adopting progressive healthcare policies at the sub-federal level could relieve financial stress and improve health outcomes among affected populations