Health insurance for Substack writers
Introducing Substack Health
When I was a freelance journalist a few years back, health insurance was a source of mystery and pain. I didn’t really understand the U.S. healthcare system and quickly realized I couldn’t afford anything other than the “Sigh... We Guess We’ll Reattach One of Your Arms After a Catastrophic Car Crash” plan. Even with insurance, my primary health plan was to try not to get sick.
My experience wasn’t at all unusual. We’ve seen at Substack that uncertainty around health insurance is often enough to prevent writers from going independent. Health care—or lack thereof—is just one more stress that an independent writer really shouldn’t have to deal with. So we’re trying to do something about it.
For the last year, we’ve been piloting a program to subsidize health care for a small number of writers and connect them with plans that they own and control. Today, we’re dramatically expanding the reach of the program.
We’re partnering with HealthSherpa to make it simple for any Substack writer to find a health insurance plan that works for them. HealthSherpa understands the specific concerns and needs of Substack writers and provides customized support, all through a user-friendly interface.
To kick start this new program, we will offer a one-time $500 health stipend to any U.S. writer who pays out of pocket for health insurance and has more than $5,000 in gross annualized revenue on Substack. You can read more about the program and apply via substack.com/health. (Applications are open until January 20, 2022 at 11:59pm PT.)
This initiative is one of many services we’re testing and expanding, including investments in legal support, design, editing, and financing. Our goal is to remove the barriers for writers to go independent and help recreate some of the support structures that are otherwise disappearing from the media landscape. We welcome your feedback, ideas, and interest in collaboration as we develop these programs and expand the impact of this work.
Learn more about Substack Health at substack.com/health.
As a Canadian, I don't need it. But I certainly do applaud it. Back when I was a freelancer for the LA Times my editor was looking to leave the paper. What she wanted to do more than anything was be a freelance editor, but she ended up taking a job with a magazine because of the health insurance. One thing that has often mystified me about the alleged "land of opportunity" is how the fear of losing health insurance keeps so many people in jobs they hate or prevents them from fulfilling their career dreams.
If health insurance was something I had to worry about, I'm not sure I'd have become an author. I am happy to be on a platform that is so thoughtful in helping their writers be successful. This sounds like a true win-win. Bravo!
... it's good marketing ... but it doesn't change the affordability math one iota - and the math here in the U.S. is brutal. Using this online "tool" (that Substack is "partnered" with), an "Expanded Bronze" HMO plan for a family of 4 is over $5,300 - per year (here in Arizona - states will vary somewhat). BUT ... and here's the kicker ... that Expanded Bronze plan has a $16,000 deductible! Anyone can use the online tool - so it begs the question - what exactly is the Substack "partnership?" Basically - it's a link to a website - which I wouldn't categorize as a "partnership."
Thanks for sharing, James. 🙌🙌
This is such a ridiculously good thing to do. So many of my US friends have been through hell with their health insurance so I know how grim it can be (I'm a Brit so this doesn't apply to me). So - yeah, this is amazing. You're doing a terrific thing here.
Thanks for the note, Mike 🙌. We're looking forward to learning from this program and building support services out further!
Hamish, what a great idea. Substack is seriously altering not just the media and writing status quo, as we see from the latest round of attacks against you, but seriously disrupting the nation's train of thought on so many fronts.
Keep it up!
Ric
Another Canadian here... but my partner is American, so I am too aware of how desperate it can be South. There's a thoughtfulness here, yes, and I appreciate that and am glad to be onboard.
Whoa! You guys are embracing and experimenting with some really great opportunities here. 😮❤️ So great!
❤️ Yes! We're excited to continue testing, iterating on, and expanding these support services. Thanks, Gail.
You bet! My experience here has been fantastic. Thank you for creating and maintaining this space.
I'm not among those who need this, but I'm so glad to see you've pulled it off. I took my current job in large part because the ACA had made it too expensive to insure my kid on the open market. That's what forced me out of freelance work.
Hi Substack team, I want to offer a little feedback on your health plan support. I think it's great you're trying to help writers with health insurance, but please know that a one-time stipend of $500 is like giving a starving person who hasn't eaten for two days $1 for a meal. It's basically pointless. An individual health plan with a $6,000 deductible is still around $350/month (or more). A one-time stipend of $500 will cover a month-and-a-half of premiums, but nothing else. Reading that doesn't even begin to get me to THINK about going independent. It offers absolutely no safety net of any kind. Please re-consider your strategy and benefits if you truly want to help -- unless, of course, this is simply a marketing ploy to make more money.
Hey Shari. Kevin here from the Services team. Thanks for the feedback. It's valuable for us to hear. Yes, a $500 one-time stipend varies widely in the difference it'll make for each writer. We've heard from some writers who are paying $500+ per month while others have insurance premiums where $500 will cover to a whole year of premiums. Based on our research, we felt that for the first iteration of this program $500 would be a meaningful amount to start with (for some writers). And that we would quickly learn more about what writers need to make a difference in their lives from feedback like yours. Thanks for writing on Substack and for sharing your thoughts.
Hey Kevin, thanks for replying so quickly. Glad to know that the feedback was received, and hoping to see the program greatly expanded soon. Understand that this is essentially the first "pilot" phase rollout, so the target audience might be different than me and others like me.
For perspective, a solo person would have to earn over $70,000/year to pay $500 per month for a benchmark silver plan in the current ACA marketplace (which is where HealthSherpa is selling). In the emergency Special Enrollment Period that ran Feb. 15 - Aug. 15 this year, the average premium paid was $81/month, and nearly half paid $10/month or less. The American Rescue Plan gave subsidies a major boost.
https://www.hhs.gov/sites/default/files/2021-sep-final-enrollment-report.pdf
This is such an amazing idea! Thank you to everyone who works at Substack and made this possible. I won’t be using it personally (or at least yet haha) but I’m sure there’s many Substack writers who will benefit from this awesome program! Thank you again 😊
This is fantastic news!
Has anyone actually put in the numbers to get a quote? These health insurance prices are INSANE and it appears that the stipend is only for one month? I appreciate the sentiment, but this is higher than my student loans.
Hey Amee, Kevin from the Services team here. Are you open to sharing what state you're checking out health plans in? We know that health insurance premiums vary widely depending on location, and this would be a good data point for our team. No pressure to share though. Thanks for writing on Substack.
This is wonderful.
✨
This doesn't apply to me just yet, but wanted to say this makes me love Substack even more. Thanks for taking care of people! <3
Thank you, Jess. And thanks for publishing on Substack. We're excited to learn from this iteration of Substack Health and continue to build up our support services so that they're eventually available to anyone who needs it.
As a health and wellness coach, this is just amazing to see. Such a great initiative. I'm up in Canada so this doesn't apply to me, but really excited to see some of the progressive steps being taken like the one you are providing here for U.S. writers. Hopefully we can see this initiative expand to a wider group of writers as the positive impact becomes more clear! Great work Hamish and the Substack team!
Appreciate the note, Paul! Thanks for writing on Substack.
A few points for people skeptical about the health insurance they may find in the ACA marketplace -- which is what is on offer here via HealthSherpa:
1. HealthSherpa is very easy to use and shows all plans available in the ACA exchanges at no additional cost to the enrollee. Try the app: you should have a good idea what's on offer and what it will cost you within 30 seconds.
2. The American Rescue Plan, enacted in March, gave ACA premium subsidies a *major* boost, and coverage in 2022 is much cheaper than many people realize. There is no longer any income cap on subsidy eligibility: if you are legally present in the U.S., don't have an affordable offer of insurance from an employer, and aren't eligible for Medicaid or other public coverage, a benchmark silver plan will cost no more than 8.5% of income, and for most people, far less.
3. Benchmark silver coverage (the second cheapest silver plan in an area) is now *free* to enrollees with incomes up to 150% of the Federal Poverty Level -- $19,320 for an individual, $26,130 for a couple, $39,750 for a family of four. For anyone with an income below 200% FPL ($25,760 for an individual, $53,000 for a family of 4), the Substack $500 stipend will cover the entire premium.
4. In comments above, Dan Munro emphasized the super-high deductibles in bronze plans (the cheapest metal level available). That's true; they're awful. And silver plan deductibles are frankly also very high in most areas for people with income above 200% FPL (see above; below that income threshold, strong Cost Sharing Reduction subsidies bring deductibles way down). But most silver plans also offer considerable services (doctor visits, generic drugs) that are not subject to the deductible.
5. In all but 12 states, if your family income is below 138% FPL ($1,482/month for an individual), you will qualify for Medicaid. HealthSherpa will show you that, too, and refer your application to your state Medicaid agency.
6. If you are uninsured, check out your options. HealthSherpa, offered in this program, is a good, quick, reliable way to do it ( I blog about the ACA and use HealthSherpa all the time to check prices in different markets, but I have no relationship with the firm). Good luck!
... and a few more points.
1. HealthSherpa is hardly unique - and there are organizations tailored to helping freelancers specifically with health insurance - like this one: https://www.freelancersunion.org/insurance/health/
2. Unless/until Substack offers a specific solution - they have no real value add to health insurance that Substack writers select through online brokers recommended by Substack.
3. I can't tell (and I don't really care), but there are often kickbacks for "applicants" or "enrollees" for health insurance bought through many brokers (online or otherwise).
I just tested the freelancers' app: it's far inferior to the HealthSherpa interface. It's true that other than the $500 grant (not nothing by any means given median ACA premiums net of subsidy), substack's only service here is to point people to HealthSherpa, but that is in itself valuable, given the widespread ignorance of ACA offerings (especially as enhanced by the American Rescue Plan) and HS's ease of use.
HealthSherpa is in fact the dominant direct enrollment platform, accounting for more than 60% of all direct enrollment by commercial platforms. More about them here. https://xpostfactoid.blogspot.com/2021/06/the-second-biggest-health-insurance.html
That's a great move.
🙌
I love this, thank you for looking out and caring for the creators on Substack
Thanks, Jen!
I'm so glad to see you guys doing this! I'm still employed, but one of the things that keeps me from leaving my job is health insurance.
I feel you, Karen. When I first went freelance my biggest stressor was health insurance. It's real! Hoping we can learn more from this program and continue to figure out ways to support writers going independent if that's what they want to do. Thanks for writing on Substack.
Fantastic initiative for US writers! Here in Canada we're so grateful for our healthcare system - even when overloaded we all do feel supported. Bravo Substack!
Thanks, Carol! 🇨🇦 Appreciate the note. And thanks for writing Personal Papers on Substack.
This is commendable. Go, Substack, go! 🙌
For the first time in my life, I have a solid health insurance plan. But I think the Substack offer is fantastic for those in need. Thank you for thinking of ways to make a writer's life more livable. I'm pleased to be associated with Substack!
Very interesting idea. I'm in a place with government provided health care but have considered moving to the United States. This is probably when I might need such a thing.
I think it'd be best if Substack stuck with newslettering & improving the platform. We still can't embed Rumble video links. We need more font options, better editor and audience engagement tools. Don't go chasing liberal utopia waterfalls.
If only we lived in a nation that wasn't cruel and understood why universal health care should be written into law.
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Can I at some point when I’ve built up my following get help with a health plan. I’m in the UK and an ex heroin addict and cos we have the NHS, which is awful, companies don’t HAVE to offer insurance to anyone. I would happily pay £1000 a month for proper, full cover for me and my daughter and her sister and mum, no lifetime limits etc. Just thought I’d ask. I struggle with the Soviet era health system - sorry, NHS. My health is generally good but my veins in my arms are shot and nurses here don’t seem to be able to put a central subclavian line or jugular line, or an arterial line for blood draws, they just treat my arm like a pin cushion. I’m not some right winger, I support universal healthcare but I also want the best for me and my dysfunctional family
I already have health insurance but it is nice to know that I have solid options elsewhere
Interesting...If they get this stipend, would this affect them if they're elegible for subsidies on the marketplace? Or is more like a one time bonus?
Wow! This is great!
This does not apply to me in any way. I'm European and I live in Europe. Health insurance is a given here. I think it's even mandatory to have. I can only imagine the worry you could have without it. And how big the threshold is to even go and seek medical advice if you're not feeling well. So, great thing to do, Substack. Thank you. Even if it's not for me. Just thank you for caring.
Please consider adding health shares as options in your program, such as Solidarity, Liberty, Samaritan. They cover naturopathic and catastrophic, which is all my family needs. We have all been happy with this for nearly two decades, paying an average of $150 per person monthly shares (premium).
And some of those companies are barely more than scams. I had "insurance" through one of them for a year and dropped it after discovering that they don't pay on many claims. And later I discovered that they refused to pay on an in-network dental claim (and even had outdated info on the insurance card that delayed the dentist - or me - finding out for months). So you need to be very careful of them.
Great initiative. I didn't see any note about data privacy. I am guessing data privacy issues regarding health care data have been considered. Personal data will be going from Substack to a third party platform, right?
Linking to an online tool for buying commercial coverage may be helpful for a small subset of freelancers, but it doesn't change the brutal math for most. Using the tool - the lowest cost of "Extended Bronze" HMO coverage for a family of 4 (with a family deductible of $16K) is still $444/month (here in Arizona) or over $5,300 annually. Keep in mind that 40% of Americans have less than $300 in savings - so the $16K deductible alone is a very real economic catastrophe for most Americans. None of this is the fault of Substack, of course, but linking to an existing online tool isn't much of an aid in sourcing health insurance that "works for them [freelancers]."
Hey Dan, thanks for the feedback and for sharing some of your expertise. It seems you have significant knowledge on this topic based on your research and writing.
You're right. The cost of healthcare in the US—especially for freelancers and especially for those with dependents—can be a huge obstacle depending on one's economic situation.
We partnered with HealthSherpa to provide some extra guidance to Substack writers looking for insurance, maybe for the first time. I think the federal and state marketplace websites are often confusing and tough to navigate. We felt that a more user-friendly experience to find an ACA plan from the marketplaces would be valuable to writers. HealthSherpa also has support team members who have been briefed to understand a bit more about Substack writers. So while we aren't able to provide independent writers access to new, substantial plan discounts yet (apart from our stipend for eligible writers), our hope is that a partner to offer guidance + answer questions would ease the challenge of understanding plans, comparing options, and making a decision.
When I first sought out insurance after going freelance in 2016, I was confused and scared. What's a premium? What's coinsurance? What isn't covered? Am I making a bad decision? Part of the burden was financial, but a non-trivial source of my stress came from not understanding health insurance. I would have appreciated a guide, someone to talk to.
All that said, part of this initial iteration of Substack Health is to learn more about what writers really need help with and what amount of support is meaningful depending on needs. We're looking forward to learning more. Thanks for being on Substack and for sharing your thoughts. And I hope to see an inaugural post on your publication soon!
I do applaud the effort, but I'm concerned that you're wading into a minefield without a detector and there's an entire cottage industry that's sprung up around "guiding" consumers thru the healthcare insurance maze.
These companies typically take a cut or fee for "delivering" enrollees so there's a very direct conflict of interest that could backfire on substack's credibility / neutrality - right?
The only truly free service I'm aware of is still healthcare.gov - which offers the broadest spectrum of plans to ALL individual consumers (nationally) and not just freelancers.
Dan, a few points:
1. HealthSherpa is a broker: its cut comes from the insurers, and it does not affect premiums. It's also the most user-friendly enrollment platform in the country, better than HealthCare.gov. Anyone who clicks through can enter their zip code, age (including of other household members), and estimated income and see what plans are available and what they will cost in less than a minute. HealthSherpa also shows all plans available on the exchanges.
2. Under the enhanced premium subsidies enacted in the American Rescue Plan in March through 2022, and likely to be extended through in the Dems' pending BBB bill, no person or family that lacks access to other insurance (employer-sponsored, mostly) will pay more than 8.5% of income for a benchmark silver plan (the second cheapest silver plan in their area). There is no longer any income cap on subsidy eligibility. And most will pay far less: silver coverage with strong Cost Sharing Reduction is *free* to 150% of the Federal Poverty Level (about $19k for a single person and costs no more than 2% of income up to 200% FPL (about $25k). At higher incomes, marketplace plans do often have high out-of-pocket costs, but many substackers are likely to be pleasantly surprised at what's now on offer.
I get all that - but we're just of entirely different mindsets.
Online brokers are designed to make buying tiered AND opaque health insurance clickably-easy - but they never really answer fundamental questions like - what quality can I expect from this "Bronze" tier - and what "network" of providers will I get this year - or next?
And even more fundamental:
- Why is there a wage tax in America on top of income just to pay for healthcare? No other industrialized country does this.
- Why is the cost of my surgery 2.5X (nat'l average) my neighbors simply because we're in different coverage tiers?
It's a different set of questions entirely - but it's also framing that's critical in challenging (and ultimately changing) the heavily entrenched status quo. Good trouble ... in the best sense ... because the legacy we're leaving for subsequent generations isn't defensible.
Apparently I neglected to hit "post" on this one:
You are changing the subject. Your comment suggested that HealthSherpa will cost people more than coverage obtained on the exchanges; that's not true. Also, HealthSherpa has decent decision support tools that estimate which plan is likeliest to cost an enrollee least, net. And like the exchanges, it prompts enrollees to enter drugs they use and providers they want in-network.
The many dysfunctions of U.S. healthcare and health insurance are your bailiwick, but none of that answers whether this offer is likely to steer enrollees to insurance affordable by American standards. The answer to that question is yes.
I have no idea what substackers' median income might be, but those who earn more than $5k on substack and less than 200% FPL in total can get *free* benchmark silver coverage with strong Cost Sharing Reduction.
It's not changing the subject because many of us are still left wondering just what this opaque "partnership" is - and partnerships between commercial entities (especially around healthcare) often include money.
The announcement was never framed as "hey - here's a list of links that could help you as a freelancer source individual health insurance on the marketplace exchanges." It was framed as a partnership - with one other online tool - where many exist. That alone is enough to raise at least one eyebrow - even if it's only mine ;-)
And that's true -- there should be more explanation -- of how the marketplace works, and how HealthSherpa works.
In the 80's I was w/ the NYPD. "Great benefits" everyone said. Yeah. Right. Not one, but TWO of my colleagues had catastrophic illnesses. One guy, his kid came down w/ Leukemia. Over the course of 3 years, he:
- went bankrupt
- lost his home
- has his income garnished to the day he dies
- and his kid died.
After my 3rd shootout, I quit and moved to Canada. Been here almost 40 years. I'm now in my 60's and thus a higher consumer of healthcare. My SIL (epileptic) had massive, massive siezures and spent a week in ICU and another week on ward. She's fine...
No lie: we bitched about having to pay for the underground parking to visit her. And laughed at ourselves.
Seriously though... maybe have someone from Substack contact people from Amazon? They're trying to put a Health Plan Network together, and there's no doubt that Bezos loves writers.
I've about given up on the idea of health reform through electoral politics. I suspect the best bet is that the private sector creates an organization that fills in the gap. A benevolent, effective, go-fund-me-type deal for coverage that would scale out to cover as many people as possible once it was strong enough to do so. Who knows, maybe this foray by Substack could be the start of such an effort. Godspeed.
Or we could just get Medicare for All.
https://prospect.org/day-one-agenda/how-biden-could-give-everyone-medicare-on-his-own/
In my opinion, health insurers should encourage insurers to take action by creating health-oriented and encouraging initiatives. To encourage and attract more people. Especially the epidemic crisis, it can impose many treatment costs on the government, it should be more active in this area.
The other trick is to live in the UK.
Also, this is phenomenal. Now if I can just get these stories done so I can sell one and serialize the other on here.
Postings aren't loading for some reason. Probably in the middle of editing them.