How Being an Author Changed After the Affordable Care Act

In case you weren’t aware, it’s hard being a professional author. A veritable cornucopia of nonsense conspires against you at every stage of this endeavor. It’s not just the constant pressure to create quality content for a market whose tastes are ever-evolving, hitting your deadlines, working with sometimes fickle editors, or getting paid on nothing resembling a schedule.

It’s only once you’re about a year into it do you realize that not only do you have all the issues of the normal creative process to contend with, but all the concerns and problems that arise from running a small business. Marketing yourself, managing your brand, and dealing with eye-watering levels of what most of us consider to be double-dipping taxation in the form of the self-employment tax.

For many years, nothing about any of this has gotten any easier, especially as the nature of the author-publisher relationship has shifted to place even more responsibilities on the creators themselves for self-promotion and driving sales. However, there has been one notable exception, one bright spark of hope for many authors, musicians, artists, comedians, and creatives of all stripes.

That spark has been the Affordable Care Act.

Prior to its passage in 2010 and full implementation in 2014, anyone who wanted to pursue the life of an independent, self-sufficient professional author was subject to the whims of the individual heath market. I knew it well, because for many years I worked as a health insurance agent in a company that sold all kinds of insurance, including the best auto insurance company, right down there in the trenches. Individual insurance was an entirely different animal from employer group plans, with its own set of rules and regulations, or lack thereof.

For starters, applicants had to run through the gauntlet of pre-existing conditions exclusions. Depending on the carrier, these ran across an incredible spectrum of ailments from the very serious, such as cancer, to the common and relatively benign, like asthma or high-blood pressure. You wouldn’t necessarily be denied coverage totally, but were often denied coverage for the one chronic condition that drove you to need heath insurance in the first place. Conditions that were often easily managed, but quite expensive.

But pre-ex was only one head of the hydra. Other issues included things like lifetime or annual benefit caps, often in the million-dollar range, which sounds like a lot of money until, like me, you’ve looked at the hospital bills for things like cancer treatments, or organ transplants. It is astounding how fast you can reach seven-digits, after which, even those policy-holders with good insurance were utterly without coverage, and had no chance of getting picked up by another carrier due to the aforementioned pre-ex clauses. The only choice at that point was to enter Medicaid spend down, which is a polite way of saying impoverishing oneself to the point they are so destitute that public assistance becomes available through the state Medicaid program.

And the hits don’t stop there! Let’s not forget that mental health services were, by and large, not something that was covered by individual plans, either counseling services or medications in most cases. Now, I love my tribe, but let’s be honest here, authors are a neurotic lot and there’s not a lot of them that don’t need some sort of help in this area.

Which is why for the longest time, authors had to make a simple calculus; keep the day job that permitted them access to the healthcare coverage and medications they needed to function and in many cases even survive, or self-insure. Unless you were one of a handful of phenomenally commercially successful authors, self-insuring was simply not on the table. As a result, hundreds of mid-list authors, many of whose sales and fanbases commanded the sorts of advances and royalties that would otherwise fund a comfortable if modest livelihood, found themselves locked into fulltime employment they didn’t want or need outside of their requirement for health coverage, draining time and energy that could have been much more productively spent creating new works and expanding their readership.

The ACA changed that equation. Suddenly, pre-ex and lifetime caps were gone. Mental health coverage became mandatory, and some level of premium subsidy was available for people all the way up to 400% of the federal poverty level through state or federal marketplaces. People who had spent their entire lives locked out of the individual market suddenly had access.

A wave of creatives quit their day jobs, or scaled back their time commitments to make their writing career a priority for the first time. The ACA provided the space many of us needed to become truly independent and pursue our talents with our full attention and energy as never before.

It’s still too expensive, and problems with the system persist in the face of an obstructionist congress that would rather see this grand experiment fail than fix the issues largely created by their own deliberate sabotage. But, against all odds, it continues to chug along, changing lives and creating opportunities previous decades of authors could only dream of.

The healthcare debate in our country is in a pause as the sides take stock and regroup. But it’s only a pause. The fight will resume soon enough. If you want to support your favorite authors, first, buy their books. Second, write reviews. But a close third is to call your reps. Let them know the truth of the ACA. That it hasn’t killed jobs, but created them. That the people using it aren’t looking for a handout, but are doing everything they can to pay their own way. To create. To contribute. To weave their own little corner of the tapestry that is the proud tradition of American storytelling.

They deserve that chance. As does everyone.

Patrick S. Tomlinson is an author and stand-up comedian working out of Milwaukee, WI. His Children of a Dead Earth series—The Ark, Trident’s Forge, and Children of the Divide—is available from Angry Robot Books. Patrick also organizes and hosts a nerdy stand up showcase known as Cthulhu’s Comedy Collective, which has recently started touring conventions in the Midwest. You can follow him on twitter @stealthygeek, on Facebook, and follow his blog.


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