‘I thought about folding’: How limited healthcare access cripples solopreneurs

Roger Sauerhaft thought he had done everything right. The 38-year-old PR consultant had been running his solo practice in New York since 2021, paying $1,189 a month for what seemed like good health insurance through his state’s individual marketplace. 

In late 2023, he developed a medical issue that required a specialist, and started calling doctors’ offices—only to be turned away again and again. The closest in-network specialist was an hour away in Long Island. 

One medical administrator was honest with him: His plan’s network was too restrictive. He needed broader coverage—but that wasn’t available to him.

“When you’re a solopreneur, your health is your business,” Sauerhaft says. “When you have a problem, you need to get it fixed really quickly. That requires access.”

Approximately 16.5 million Americans were self-employed as of January 2026, according to the Bureau of Labor Statistics. MBO Partners’ 2025 annual survey puts the number at 72.9 million, counting not just full-time self-employed workers but also part-time and occasional independent earners.

For solopreneurs and small-business owners across the U.S., individual marketplace plans are predominantly HMOs, or health maintenance organizations, which have narrow networks and require referrals to see specialists. PPOs, or preferred provider organizations with broader access, are available on marketplaces in only a handful of states or through employer-sponsored plans.

Most solopreneurs across the U.S. get their insurance from Affordable Care Act marketplaces. Premiums, deductibles, and out-of-pocket costs can eat up a significant portion of their income, and many plans restrict access to care through narrow provider networks. This gap leaves many paying high prices for plans that don’t meet their needs, forcing them to choose between their health and their business—or find creative work-arounds to access better coverage.

Making it work

For Sauerhaft, HMOs were the only plans available on his state’s ACA marketplace, complicating his search for a nearby specialist. He looked at options from the Freelancers Union, but couldn’t find anything better and began questioning the future viability of his business.

 “I thought about folding the business at that point,” he says.

Instead, he expedited his wedding by a few months so he could join his fiancée’s employer PPO plan. He had gone independent to chart his own path, but the system “had basically taken it away from me,” he says.

Liang Zhao, 38, was able to set up her own independent PR practice in 2019, in part because she had access to health coverage through her husband’s employer. But in September 2025, her husband was laid off. Their premiums for a family of three jumped from around $700 to $3,000 per month under COBRA (the Consolidated Omnibus Budget Reconciliation Act, a federal law that ensures individuals and their families are able to maintain access to healthcare coverage during certain life events, such as job loss).

“We’re literally one layoff away from an entire family losing coverage,” Zhao says. “Historically, this country has set up a system where health insurance has been distributed through employers, so the whole system benefits larger employers who are able to negotiate better rates for their employees.”

Solopreneurs who can’t rely on a spouse’s coverage have to get more creative. 

For Bob Christie, an independent consultant based in New York who travels across the country for his work, having nationwide coverage is a priority—but the state marketplace offers plans that work only in New York, or other states in an emergency.

A broker connected Christie with Iron Health Benefits Partners, a Nebraska-based company that works with independent contractors. He technically became their employee—filling out a monthly questionnaire for token pay—which gave him access to their Blue Cross Blue Shield of Nebraska group plan with nationwide PPO coverage. His premium: $1,321 a month.

Barriers to growth

When it’s time to expand, health insurance can be a formidable obstacle. Alvin Carlos, 34, a financial planner in Washington, D.C., built his solo practice into a five-person firm and knew he needed to offer coverage to attract and retain talent. But when he explored group plans for his five employees across five states, a broker’s quote came to $8,010 a month—more expensive than individual coverage.

His solution was to turn to a Health Reimbursement Arrangement, or HRA. Carlos reimburses employees $300 to $1,000 monthly depending on whether they’re single or have a family, covering premiums, copays, and deductibles. HRAs are a tax-advantaged benefit that gives employees flexibility to choose their own plans. He’s increased the reimbursement once in 2026 due to premium spikes.

“Our health insurance system is broken,” Carlos says. “It is so expensive and it is so complicated.”

Navigating the rules

Sole proprietors and companies with few employees have to wade through a patchwork of state-specific rules, shifting eligibility standards, and premiums that keep going up.

“They’re in a very precarious position right now,” says Jesse McDonald, a health insurance broker based in Milford, Connecticut. “U.S. healthcare costs keep escalating, so the insurance that’s covering it gradually escalates. It’s been a problem that’s been getting worse and worse.”

McDonald said enhanced premium tax credits during the pandemic briefly eased the burden for many independent workers, lowering monthly premiums and expanding eligibility. But those enhanced subsidies expired at the end of 2025.

Jennifer Chumbley Hogue, a Dallas-based health insurance broker, says 22% of her clients qualified for subsidies in 2025. Of those clients, about half went without coverage in 2026 after losing that support. 

Still, she cautions solopreneurs not to assume they’re out of options, recommending they consult brokers with extensive knowledge of their local market and rules.

Fixing the access gap

For Sauerhaft, the barrier isn’t cost but breadth of coverage.

“Even if I had to pay $2,000 a month for a PPO, I would have done it,” he says. “It wasn’t about affordability—it was about getting access.”

He believes his state’s marketplace could better serve solopreneurs if it offered more middle-ground options between restrictive HMOs and PPOs—or allowed people to pay more for greater provider choice. 

Sauerhaft, whose own coverage crisis nearly derailed his business, sees the pain as a catalyst for change. 

“The more people who get caught in this broken system, the more awareness there will be, and hopefully pressure to fix it,” he says. “I am heartened by the fact that things are already much better today than they were 20 years ago, but progress can be slow.”

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