workforce

Rebecca White really didn't enjoy being yelled at all day.

In her job as a telephone support representative for a bank, White — a Louisville, Kentucky, educator — had to contend with abusive colleagues, monotony, and patchy training that left her baffled by customer questions she was often unable to answer.

It was a job she felt she had to take. Struggling through a series of part-time teaching gigs left her with inadequate care for her diabetes and kidney problems. Relying on Planned Parenthood and other free or low-cost clinics for basic treatment was not working anymore. The job offered her health insurance — even as it left her glued to her chair for hours at a time, exacerbating her medical issues.

"It was really rough on me to be as immobile as you have to be. There's no moving around," White says.

A month after the most recent legal challenge to the Affordable Care Act (ACA) was struck down by the Supreme Court in June 2015, White quit her job.

She now receives insurance through Kentucky's Kynect exchange while working part-time as a substitute teacher and launching her own tutoring business. Emotionally — and physically — she's in a better, more secure place.

Before the Affordable Care Act, if you got seriously sick, and didn't want to go bankrupt, having a have a full-time job with a good health plan attached was essential.

In 2008, a Harvard Business School study estimated that 11 million Americans were stuck in jobs they would prefer to change or leave because those jobs offered health care coverage.

In the years since ACA's passage, millions of those Americans have been able to leave those jobs and try something new.

Data on the law's effect on "employment lock" — workers staying in unwanted jobs because those jobs offer health benefits — is mixed. A Princeton-Cornell study recently detailed in a working paper found that the ACA's Medicaid expansion produced no substantial short-term job shifting among lower-income workers. Meanwhile, an analysis by the Center for Economic and Policy Research found a 10% increase in voluntary part-time workers since the first quarter of 2013.

The latter figure includes people, like White, who suddenly found themselves free to leave toxic or harmful work environments to pursue alternate or self-employment as well as others who discovered that working a series of projects, rather than a single full-time job, was a boon to their career growth and personal lives.

James Sasek, an IT worker in Des Moines, Iowa, discovered that the flexibility to jump from project to project afforded by his ACA insurance allows him to better balance work and family.

Sasek found access to the ACA's health insurance market invaluable after his wife was laid off from her banking job shortly after giving birth to their second child. The law allowed him to leave his own frustrating job and go freelance, something both he and his wife had long desired.

"Our plan is to take advantage of our gaps in employment to enjoy our kids' childhood with them," he said. "If one of us has a few months off between gigs, it's a really great and unique opportunity."

In addition to the flexibility to spend time with his family, Sasek explained that he earns more money in his freelance gigs than he did in his old jobs and that the ability to take on a diverse array of projects allows him to consistently add new skills to his resume.

For David Rigano, a theater director and playwright in New York City, the ACA was both a hurdle and a blessing.

After graduating from college, Rigano took a part-time job at Trader Joe's to secure a steady income and health insurance. When the ACA was passed, he was informed that he would need to scale up his hours to stay on his employer's health plan. Instead, he transferred to a plan on the exchange, which allowed him to continue to work a part-time schedule that helped him pursue directing and writing jobs.  

"I learned a lot that year about applying for insurance as a freelancer whose work from year to year changes," he said.

With the freedom to work any job — not just one that offered him insurance — he landed a gig as a guest services representative at New York's Lincoln Center, which doesn't offer a health plan, and left Trader Joe's in December. His new job offers him a steady paycheck in his chosen field and lets him do personal projects on the side.

Some of the same folks are nervous that the law's repeal will jeopardize the gains they've made in their lives and careers.

Nearly 16.4 million people have gained insurance coverage since the ACA was passed in 2010, prompting many of them, like White, Sasek, and Rigano, to make big personal and professional decisions.

Unsurprisingly, the prospect of seeing the law scaled back — or done away with altogether — is setting their nerves on edge.

"If we go back to pre-ACA, my family will have to work more, have less choice in jobs, and spend less time with our children," Sasek said. It's a message he frequently relays to his local and national legislators.

Without coverage on the ACA's health care exchange, Sasek explained, either he or his wife would have to find work that offers it, giving them less flexibility to chart their careers or spend time with their kids.

White, meanwhile, worries about returning to a job that mistreats her. "Even if I can find one — and I looked a good long time before I got the bank job — if this is accompanied by the economy tanking again, and I'm pretty sure it will, things will just be a disaster," she said.

As the 115th Congress debates what to do with the ACA, the people who depend on it are waiting and watching.

With a Republican administration incoming, Speaker of the House Paul Ryan has vowed to repeal and replace Obamacare this year. While the repeal part is self-explanatory, it is unclear what a potential replacement would look like.

For now, Rigano's theater career is on the upswing. In recent years, he's seen more paying directing jobs and is mounting a production of a new science-fiction musical in New York.

That trajectory, he worries, is what's at stake for him in the coming months.

"I think that a complete repeal without something comparable replacing it will result in a lot of people who need to find jobs and can't build careers," he said. A vastly scaled-back Obamacare would leave him with a tough choice: to compromise his goals for the sake of his health.

Like many of the law's beneficiaries, he hopes he doesn't have to choose any time soon.