Freelancers in New York State Get a Health Insurance Plan
Working Today, through its affiliated Freelancers Union, established the for-profit Freelancers Insurance Company and began designing a health plan model for freelancers in New York state that will combine catastrophic insurance coverage with coverage for prevention and wellness services.
- Launched a for-profit subsidiary, Freelancers Insurance Company, to offer health care coverage to members who live or work in New York State.
- Developed a network of mental health providers in New York who will offer discounted services to Freelancers Insurance Company policyholders.
The Robert Wood Johnson Foundation (RWJF) supported this unsolicited project with a grant of $380,000 from July 2007 through June 2009.
More than 30 million people are now employed in the United States as independent workers, freelancers and part-timers according to Sara Horowitz, J.D., M.P.A., executive director of Working Today. They lack access to employer-based health insurance and often earn too much to qualify for public health insurance programs, but too little to afford quality individual plans.
As a result, independent workers may go without coverage, compromising both their health and financial stability, according to Horowitz. Consumer-directed health plans with high deductibles have reduced premiums, she said, but "effectively discourage the use of ongoing care that promotes wellness since consumers pay for preventive care out of pocket."
Horowitz founded Working Today in 1995 to serve the needs of the independent workforce. Working Today established the Portable Benefits Network in 2001 to deliver benefits and discounts to independent workers, initially in New York State, and renamed it the Freelancers Union two years later. Freelancers Union now has more than 130,000 member and offers dental, life, and disability insurance nationwide through contracts with insurance companies. Freelancers Insurance Company offers health insurance benefits in the New York area.
For more than 30 years, RWJF has been concerned about Americans' lack of access to affordable and stable health care coverage. RWJF has funded studies, demonstration projects and symposia about this problem.
In 1997, Congress funded the State Children's Health Insurance Program with the aim of providing health insurance coverage to children who were not eligible for private or other public insurance programs. That same year, RWJF created Covering Kids® (see the National Program report). In 2001, RWJF reshaped the program and renamed it Covering Kids & Families®, reflecting the Foundation's commitment to help states also cover parents and other adults who work in jobs that do not provide health coverage for them or their children.
Through a series of State Coverage Initiatives, RWJF assisted states in developing and implementing policies that made health care insurance more available and affordable to low-income residents. RWJF also created State Solutions: An Initiative to Improve Enrollment in Medicare Savings Programs, a national program to maximize enrollment in Medicaid, Medicare and other health insurance programs. Communities in Charge: Financing and Delivering Health Care to the Uninsured is a national program to help cities or counties improve access to care for low-income, uninsured individuals by changing the organization and financing of local care delivery. The Access Project began work to improve health and health care in 1998.
RWJF has also supported other efforts to enhance Americans' access to health care coverage, including:
- Understanding costs and financing mechanisms through Changes in Health Care Financing and Organization.
- Analyzing proposals to expand coverage through the Economic & Social Research Institute's Covering America project.
- Helping states plan and develop insurance market reforms to expand health coverage for the uninsured through State Initiatives in Health Care Reform.
- Increasing awareness among policy-makers and action by the general public through Cover the Uninsured Week.
Working Today, through its affiliated Freelancers Union, established the for-profit Freelancers Insurance Company in New York State and began planning an insurance model that combines coverage for catastrophic health events with discounted prevention and wellness services.
Project staff conducted surveys and focus groups with Freelancers Union members and health care providers to identify their needs. Initial discussions focused especially on mental health care and produced these observations, according to the project director:
- Consumers care most about the affordability of care and maintaining continuity with their providers.
- Consumers want holistic, "full-person" care and see mental health care as part of the framework for achieving wellness.
- Since insurance plans can offer varying amounts of coverage for treatment, consumers often cobble together care among multiple providers, juggling coverage and out-of-pocket costs.
The Rockefeller Foundation, the New York State Health Foundation, the Ford Foundation, the New York City Investment Fund and the Prudential Social Investments Program provided additional startup funding for the Freelancers Insurance Company.
According to project director Sara Horowitz and a report to RWJF, the Freelancers' Union:
- Launched a for-profit subsidiary, the Freelancers Insurance Company. Wholly owned by the Freelancers Union, the company is an insurance carrier that offers health care coverage to members who live or work in New York State. (Elsewhere, the Freelancers Union contracts with other insurance companies to provide coverage.) As of October 2009, FIC had more than 21,000 policyholders, two-thirds of whom were uninsured or on temporary coverage.
- Developed the protocols for an online, searchable database that will link members with providers of wellness services. This network has been tested in focus groups to test ease of use.
- Developed a network of mental health providers who will offer discounted services to Freelancers Insurance Company policyholders. Based on input from the surveys and focus groups, project staff determined that members most valued personal connections with providers, rather than education, experience or approach, and so decided not to vet provider credentials.
In addition to the Freelancers Union Web site, Freelancers Insurance Company has publicized its health care coverage through webinars, YouTube videos, New York City subway advertising and social networking sites, including Facebook.
- Listen to what consumers want when designing new models for providing health insurance. Surveys and focus groups helped to shape the services offered through the Freelancers Insurance Company. (Project Director/Horowitz)
After the Grant
Freelancers Union plans to launch an online directory of the mental health providers willing to offer discounted services to FIC policyholders in the fall of 2009.
The long-term goal of Freelancers Insurance Company is to continue to investigate methods of health care delivery to lower costs and improve wellness, as well as to create a health plan that offers "a la carte" services, including mental health care, physical therapy, massage, nutrition counseling, chiropractic and acupuncture. Sara Horowitz described it as "like the Dell model of putting together a computer," in which consumers select only the services they need. Project staff hoped to add other prevention and wellness services in the first six months of 2010, based on priorities identified by members, and eventually to expand to other states.
Freelancers Union also planned to explore ways for members to prepay for care, beginning with mental health services. The idea is that consumers will purchase "units of service" in advance (say, four visits to a mental health provider) in order to reduce the cost and administrative burden of paperwork.
GRANT DETAILS & CONTACT INFORMATION
Using consumer-directed health plans to encourage preventive and wellness care
Working Today (Brooklyn, NY)
Dates: July 2007 to June 2008
Sara Horowitz, J.D., M.P.A.
Report prepared by: Paul Jablow
Reviewed by: Karyn Feiden
Reviewed by: Marian Bass
Program Officer: Nancy Barrand