How would the Affordable Care Act repeal impact independent developers?

"After all the talk about small business and creating jobs, anything that makes it scarier to strike out on your own and start a new business is a loss to our entire economy."

Without the Affordable Care Act, developer Alex Preston would never have made Hyper Light Drifter. Not because he would have been financially crippled from the cost of paying for health care out-of-pocket while making the game—though that certainly would have been the case. But because, in his words, he “would probably be dead.”

For some developers, getting coverage under the ACA gave them the confidence and security to leave their corporate jobs (and, with it, traditional benefits packages) behind to start or join small independently-owned studios. For others, it supported life-saving care that they otherwise could not have afforded.

Now that the Trump administration prepares to deliver on promises to “repeal and replace” the current system, the many indie devs among the 20 million individuals who gained healthcare coverage under the ACA are scrambling to figure out their options. Complicating this is the uncertainty of what such a replacement might look like—if there is one at all.

Last week, the International Game Developers Association issued a release urging those who rely on the ACA to call their local representatives and voice their concerns. Their involvement in the national conversation makes sense: A 2015 IGDA survey of nearly 3,000 freelance developers found that 32% relied on government plans.

"Do I go bankrupt and go into the hospital or do I sit here and hope I stay alive?"

“We believe that affordable healthcare is not only about ensuring the personal well-being of individual developers, but also that is a matter of the creative health of our industry," says Kate Edwards, executive director of IGDA.

“If affordable healthcare options are unavailable," she adds. "We may likely see a significant drop in developers pursuing independent game development, which equates to a net loss of innovation and creative content for our industry.”

Before implementation of the ACA, Preston couldn’t get coverage of any kind. His health began seriously declining in his 20s. Though he briefly worked for a company that offered benefits, he couldn’t hold down full-time employment because of his health issues.. He was covered under COBRA for 18 months but, because of his congenital heart disorder and other pre-existing conditions, insurance companies turned him down when he tried to buy his own policy. As a result, he paid out of pocket for years. 

“It often becomes a question of: Do I go bankrupt and go into the hospital or do I sit here and hope I stay alive?” he said. “Hope isn’t going to do it for millions of people with critical conditions that can’t live without their medication and can’t live without an emergency room to go to.”

Without coverage, Preston’s medical bills were massive. At one point, Preston had to organize a GoFundMe fundraiser for a $25,000 hospital stay.

"Did you smoke in your twenties? Doctor spotted a cancerous mole? Pregnant? Companies had myriad reasons for denying coverage."

His experience was common. Bekah Saltsman, who runs Finji (Night in the Woods, Overland, Feist) with her husband, Adam Saltsman, said that friends “would straight up send money” to fellow devs in need. Like Preston, most of the devs they knew when they were living in Austin, Texas couldn’t get covered.

“They didn’t have health insurance,” Bekah Saltsman says. “None. Not because they didn’t want it, but because they couldn’t buy a plan on the individual market because a doctor had coded something wrong or because of pre-existing conditions.” Did you smoke in your twenties? Doctor spotted a cancerous mole? Pregnant? Companies had myriad reasons for denying coverage and, thus, mitigating their potential losses.

“This was pre-Kickstarter and pre-Twitter, and we’d send a message around that someone is really sick and can everyone please send a check,” Bekah Saltsman says. “If you were well connected enough, you might know people who could send $500 or $1,000 to make sure you don’t die from whatever you had and that, if you don’t die, you could make it through possible bankruptcy.”

She opted to stick with a formal job for the health benefits until 2008. After that, when both of the Saltsmans had gone independent, they had to be strategic: Insurance companies tried to deny coverage because Adam has a lethal peanut allergy and carries an inhaler due to childhood asthma. Even so, they were able to get coverage as a group of two, leapfrogging to different plans once they had children.

Still, within a five-year span, Bekah Saltsman’s rates tripled from $560 a month to $1,500. “When I saw the ACA plans I was like, hallelujah.” Even though the Saltsmans didn’t qualify for subsidies, they were back to paying $585 to $600 per month during that first year.

When Steve Gaynor left 2K Marin to co-found Fullbright (Gone Home and, upcoming, Tacoma), he didn’t have any health insurance. He was pinching pennies and, as he says, “It was on that list of things that we felt we could live without.” It wasn’t until Gone Home was released in August 2013—just before the first open enrollment period under the ACA—that he got coverage. 

"The ACA gave us the confidence to quit our jobs. The reason I stayed in a job I didn’t love for so long was because we needed health insurance."

Today, Fullbright provides stipends for team members to cover their insurance through the ACA Marketplace. “And we have confidence that insurance for the people we employ will be accessible,” Gaynor added. “When you’re running a studio like ours where everyone’s productivity and level of engagement is crucial, we want don’t want employees worrying about where their healthcare is coming from or how they’re going to pay for bills and appointments.”

Since then, Fullbright's coverage has come in handy: Gaynor and his wife were involved in a serious car accident and his co-founder Karla Zimonja had unexpected surgery. 

Gaynor says Fullbright plans to continue to offer their employees stipends, no matter what happens with the ACA. But, as those expenses become unreliable, it will be harder for them to budget the cost—a big unknown for a small business. “That security was really valuable,” he says. “We know ACA has reliable options, and that makes us more able to employ people and make our studio run smoothly.”

Since getting covered under the ACA, Alex Preston has had several life-saving procedures, including having a valve replaced in his heart in 2015. In 2013, he started Heart Machine, a studio named, in part, to honor of the open-heart surgery he underwent as a child and the later installation of his pacemaker. Now, due in part to the success of Hyper Light Drifter, Preston can afford insurance outside of the ACA Marketplace for his employees. 

“I count myself lucky,” he says. But he worries about what might happen if he and his business are in a position where they can’t take on that cost anymore—and what might happen to his own health coverage if his business were to fail. “I worry about that future now, and I didn’t just a year before.” 

If the ACA is repealed and not replaced with something tenable, Preston says some devs he knows plan to go back to work for larger studios and AAA companies. One dev even half-joked about moving to a different country to secure coverage..

"After all the talk about small business and creating jobs, anything that makes it scarier to strike out on your own and start a new business that didn’t exist before is a loss to our entire economy."

“The ACA gave us the confidence to quit our jobs,” Bekah Saltsman says. “The reason I stayed in a job I didn’t love for so long was because we needed health insurance.” Bekah and Adam Saltsman aren’t sure precisely what they’re going to do—so much is uncertain. But they have multiple plans and back-up plans, from going through Michigan to buy their insurance to hiring another person so they can get a company plan (which would mean changing the entire structure of Finji) to Bekah returning to a corporate day job and working on Finji projects at night.

Bekah Saltsman says some indie devs are thinking about getting a non-game related day job with benefits, even if it means working the minimum number of hours required at a place like Starbucks—provided that it even still offers insurance under the new healthcare systems.

Another option is going through IGDA, which currently partners with HUB International insurance to provide some health, plus business and liability, insurance for its members. Right now, IGDA offerings are limited by the ACA, meaning that their options are no different from what is nationally available. “However, should the ACA be repealed and no alternative is readily available, we will quickly pursue the generation of a coverage option for our membership,” Edwards wrote. “In consultation with our insurance partner, it’s clear that it’s too early to tell how this will play out.” She recommends that people considering their options tune into HUB International’s webinar on February 7 called “Repeal, Replace or Remodel? What Lies Ahead for ACA and Your Health Plan.” 

Though the president has suggested he will keep guaranteed coverage for pre-existing conditions and allow children to stay on parental plans until they’re 26, it’s unclear what will actually happen. Devs looking to protect themselves should consider finding a mentor in the industry with advice about how to navigate the healthcare system, come up with back-up plans, learn as much as possible about how freelancers got coverage before and after the implementation of the ACA, and stay apprised of how the Administration moves forward with a repeal.

But, no matter where things land with the reformation, it’s likely that the indie game scene will see a big shake-up in the coming months.

“Anything that gives people more reasons to not try to do something in an independent setting is a real loss for our industry and the economy,” Gaynor says. “After all the talk about small business and creating jobs, anything that makes it scarier and less accessible to strike out on your own and start a new business that didn’t exist before is a loss to our entire economy.”

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