Health care — and the affordability of insurance — was front and center in the shutdown debate. But even as the government reopens, both parties will still confront the challenge of expanding affordable health care coverage to more Americans. For innovative, bipartisan solutions, federal policymakers can look to the states.
Private employer-provided health care is the leading source of health insurance for the U.S. population (covering 53.7 percent) and is predominant among working-age adults (62.9 percent). Despite public efforts and the private market, 27 million Americans — 8.2 percent of the population — were uninsured in 2024, with working-age adults constituting the largest share. Among the uninsured is a growing segment of the American workforce for whom employer-based benefits are not an option: freelancers.
Self-employment and freelancing enjoy a long tradition in the United States, reflecting the nation’s entrepreneurial spirit. From seasoned professionals to Gen Z influencers to gig workers, an estimated 73 million people freelanced in 2025. Unlike traditional employees, independent contractors set their own schedules, work from anywhere and choose their clients. Flexibility is their motivator.
Women are particularly attracted to independent contracting because they can balance caregiving for children and aging parents, or managing health conditions, with gainful work. More than 80 percent of independent contractors prefer their work arrangement to traditional W-2 employment, according to government data.
The great majority of independent workers are earning supplemental (not primary) income. Many of them have access to benefits, such as health care, through a spouse’s coverage or their W-2 jobs. Still, 29 million self-employed workers who also had traditional jobs in 2019 said they lacked health insurance through their employer.
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