I'm a freelancer living feast or famine to survive on US healthcare - and I'm scared of what comes next

• Years ago, people predicted the US would become a free-agent nation full of contract gigs.
• But as a freelance writer trying to make it on US healthcare, I struggle to see the sustainability.
• Unless something changes, our ability to achieve the American dream is significantly limited.

I never thought much about health insurance until I was T-boned at 50 mph.

The wreck totaled my car. It deployed all of the airbags, burst all of the windows on the left side, and displaced the entire engine from the nose of my Honda CR-V. If the driver of the other car had hit me just a few inches lower, I likely wouldn't have been so lucky.

There had been mild pain in my back for about two months, but the crash increased it threefold. It was after this that I took my first real visit to a chiropractor and physical therapy clinic, but I only paid for two visits before I dropped out.

The reason? I'm a freelance writer.

US healthcare affects the freelance economy in a major way. A study in 2018 showed that more than 40% of all freelancers saw healthcare as their biggest concern for the upcoming midterm elections. In that same study, more than 41% of respondents claimed that healthcare benefits were the reason they chose to pair "side hustles" with their full-time jobs rather than go fully freelance.

There are roughly 56.7 million American freelancers today, many of whom are responsible for their personal healthcare costs and insurances. Without employer premiums, which offer discounted rates and bonuses, we're entirely and totally on our own.

Even with Medicare and government marketplace programs, less than one in four freelancers reported buying insurance in 2019 - and 35% of freelancers choose to neglect healthcare due to high costs and steep premiums, which averages a whopping $484 a month for a single person. For families and married couples, that number rises to $1,230.

There are credit systems that help freelancers pay for insurance, as well as a few marketplace programs that try to make a difference. But writers operate on a feast-or-famine lifestyle, which is unable to accommodate exorbitant healthcare costs. Even published authors are unable to qualify for benefitted plans outside of the insurance marketplace.

Suppose my writing takes off one year, and I'm able to live comfortably. This means my insurance credits dry up, and I am liable for the entire sum tacked onto my taxes. Insurance credits, like taxes, flex with your income bracket. Their purpose is to help pay down insurance premiums.

For example, you might only pay for half the premium if your income falls below a certain threshold. But insurance credits aren't the perfect solution you might be dreaming of. If you happen to make more or less than your declared income (which will never be exact for freelancers), you might be in for a nasty surprise. And if you happen to only have one good month in a 12-month year, your resources for healthcare are still shot.

Bear in mind that freelancer taxes are already impressively steep; the cost includes your income tax plus 15.3% charged for being your own boss. This means less money can be saved for healthcare purposes - plus deductibles, plus vital care that isn't covered by the policy.

If I make less money another year, insurance credits kick in. I might pay less per month, but I'm still liable for enormous deductibles and higher premiums just to access the care I need. And if I happen to make great money only in the last month of the year? My credits are gone again, and I have the devil to pay come spring.

You might think that neglecting health insurance is an option. I did, for a time. But the pain between my shoulder blades reminds me that passing on quality healthcare is no longer doable.

According to statistics, healthcare averaged $11,000 per person in 2018. By 2028, costs are projected to rise to $18,000. Where I live, the cost of an ambulance is $500, plus $12 per mile until you reach the hospital. Insurance protects us in the event of cataclysm, but it won't protect us from the costs that matter.

Writers aren't employees. We don't have set hours, we don't report to anyone, and we certainly don't have PTO. I can't decide to leave work early on a Friday for a dentist appointment, or take vacation time for surgeries. If I can't make the time, and if I can't access doctors that require certain types of insurance, I go without.

I'm a freelance writer who chose to invest in healthcare for the long-term. Because of my field, and because I live alone, I simply can't afford to be sick. I don't have access to a spouse's insurance.

Whether it's due to scheduled deadlines or just paying the bills, downtime is a cost I can't afford. But shelling out hundreds of dollars per month and having to pay thousands more in the event of an accident doesn't seem like much of an alternative.

And if COVID-19 puts me in the hospital, my career is borderline finished.

Since the start of 2020, I've submitted more proposals and pitch requests than I can count. I spend two or more hours a day just trying to find gigs. It doesn't take a rocket scientist to realize things are drying up. During a pandemic, it's harder than ever to take the leap of faith into freelancing. As of 2020, 28% of freelancers stopped working due to contract cuts, failing job opportunities, and limited growth.

As less and less money gets saved, I get more and more worried about the future of my health in a world that operates with an employer-employee relationship.

A few decades ago, people were predicting that the US would become a free-agent nation, composed of freelancers and contract gigs. But self employment is not a growing trend. We are a small portion of the workforce that gets overlooked and underrepresented. There aren't a lot of us saying anything about our healthcare woes, and as COVID-10 variants continue to circle, insurance worries will continue to grow.

Unless something changes with the way writers like me source and access insurance, our ability to achieve the American dream is significantly limited.

I don't need much to be happy. Dollar signs and restful nights are a bonus, but not the end-all, be-all. In the end, the American dream is the pursuit of fulfillment, or what we were meant to do. All I need is my writing, my wits, and my health.

And if healthcare isn't there for the latter, where will freelancers be in a post-COVID-19 world?