Decent has to stop offering affordable health insurance to self-employed people in Texas.

What happened

Last week my company Decent and our partner the Texas Freelance Association (TFA) were required to stop offering the most affordable ACA-compliant health insurance in Texas to self-employed people without employees. The timing was rough: we were two weeks into Open Enrollment, the only time most Americans can buy insurance during the year, in the middle of a global pandemic.

We were on track to serve thousands of self-employed people and their families Texas-wide by January 1st. We’ve been doing exactly what we were originally approved to do, with zero complaints, violations, or solvency issues. But the Texas Department of Insurance let us know that due to the unresolved status of an ongoing federal court case from 2018 that does not involve us, we need to stop serving self-employed people without employees at the end of the year. After trying hard to find a mutually acceptable path to offer coverage through 2021, we notified our impacted members immediately.

This hurts, for reasons deeper than business.

I started Decent when I was self-employed and paying more for health insurance than for rent for my family of four. Most of my team has been self-employed, and we know how hard and how important it is to afford good health insurance. We help self-employed people and small businesses band together to self-insure and save money, like 90% of big companies do. We have the most affordable ACA-compliant plans in Texas, all built around direct primary care to keep people healthy, including virtual primary care options in rural areas. Our care model works, consistently keeping members healthier for less money, and we have great network partners like AXA, HCA, and Costco Health Solutions. We work with hundreds of top tier brokers. But due to regulatory constraints, we now can’t serve the very people we made plans for.

Self-employed people love our plans. We have a Net Promoter Score (NPS) of 79 in an industry where the average score is 14 and the top 5 carriers average -20: that’s like having Apple’s customer satisfaction when the incumbents have Comcast’s. Here are some messages and testimonials from the self-employed members we’ve been proud to serve:

• “I’ve been incredibly happy with the insurance so far. Not having insurance, or being able to afford GOOD insurance, while being self-employed is a scary thing. Decent makes it possible to have great coverage for reasonable rates.”
• "Decent was a godsend for us. (Personal information omitted.) Genuinely nice, thoughtful and caring people. After almost 24 years of being insured by other companies and then uninsured for a few months, it is remarkable how different our experience has been with your company. Also, I wish I had been part of the people investing in Decent."
• “When (I've contacted Decent) for help or questions, I’ve received prompt, courteous, HELPFUL info. It’s felt like we’re on the same team in trying to obtain good, fairly priced medical services. It’s been a pleasure working with Decent & I hope to renew in 2021!”
• “Can call a human, high-touch, got me a refund I didn’t ask for, lowered premiums when costs went down. Feel like they’re on my side.”

Nothing in my career has made me as proud as serving these people.

Since telling them we can’t do that, we’ve received emails like this:

“To whom it may concern,

As a young adult who came into her financial independence in the time of required healthcare due to Obamacare, healthcare and health insurance has always been a huge stressor. I was constantly either charging my health insurance (which didn’t cover any appointments and had a super high deductible) to credit card debt or going without and opting for the end of the year fine and chancing my health without any kind of insurance backup.

Last year when I found out about the Decent plan I wanted to cry. It was affordable monthly, and the appointments were affordable. For the first time in my adulthood I took care of health concerns that I would have never been able to afford otherwise. (Personal information omitted.) I had a direct resource for COVID information and questions. As a student and a self employed business owner, this plan meant so much to me. I was finally taking control of my health and finding answers for nagging ongoing issues. I felt like this made me a better health professional, and less likely to be a health burden on society in the future.

If at any point in 2021 Decent becomes available for self employed individuals again I will gladly switch back. My only options for plans for 2021 now are paying close to the same premium but with over $8,500 deductible and 0 appointments covered until deductible is met. I am a young, healthy, health-progressive, health-conscious individual. The fact that I cannot find a good, affordable plan is so disheartening.

Thank you for the opportunity to share how this change affected me. I am hopeful to be able to work with Decent again in the future.”

And these:

• “Decent … has been my most positive experience in a decade. Everything and everyone has been straightforward and easy-to-reach. The interaction I had with my PCP is one of only 2 truly positive healthcare experiences I’ve ever had. I was actually excited when I saw the policy for next year … with the option of an HSA. It felt like a weight was lifted with regard to a pandemic going on and knowing I would still have good coverage if an emergency happened. Knowing that I cannot enroll in this plan and having researched my alternatives, genuinely leaves me crestfallen. It felt like this whole journey with self-employment, the exchange, and then temporary plans was finally resolved with Decent. They and companies like them should be allowed to provide an additional service, because at this time, the market is falling short.”
• “My wife and I have been self-employed for 20 years and we have always struggled to find a good healthcare provider at an affordable price. When we joined Decent, we were slightly wary only because it was a new company, but it has been an amazing experience. The customer service is impeccable, the plan was easy to understand and the prices really helped our bottom line. For the first time we were actually excited about a healthcare provider. This news that our coverage would be terminated due to regulatory issues was quite a shock and deeply upsets us. We hope to one day work with Decent again. In the meantime we will need to scramble to find one of those other alternatives that were not ideal for us. Please fix this!”
• “I’m going to stay optimistic that this is only temporary. I did look into the Oscar plan and will have to spend an additional $150/month.”
• I hate to have to go back to healthcare.gov to try to find a new policy. I really loved having Decent.”

As our ally and broker partner Kristin Anderson from Catch Benefits wrote, “The real loss is that you made something good and now people can’t have it.”

Like hell they can’t.

What we’re doing about it, and how you can help

Decent and the Texas Freelance Association aren’t going away. We’re not in trouble, and we’re not leaving the market. In fact, Decent just raised a Series A and will be expanding into new states soon.

Our team is shocked and hurting for our members, but we are committed to our mission of affordable healthcare for all, and we know we’re building something good for people. We know that a self-employed person doesn’t become any less special the day they hire their first employee.

We will continue to offer plans to employers Texas-wide with the same 40% savings vs. market rates, direct primary care, and high NPS  —  starting with employers in the technology industry, like startups, with plans for more industries available in the coming months.

The bigger we get, the better we can fight for self-employed people. While we figure out how to serve the self-employed again, you can help by introducing me (nick@decent.com) to Texas startups and tech companies who may like our plans.

We are evaluating different structures that could let us serve all self-employed people.

We are hopeful that the ongoing federal case will resolve favorably, so we can go back to doing what we were originally approved to do for self-employed people while we continue to serve small businesses. Either way, we are working with supportive lawmakers at both the state and federal levels to craft legislation that protects affordable and comprehensive health insurance options for the self-employed.

If the lack of affordable health insurance options for self-employed people has impacted you, please share your story at stories@decent.com.

If you have powerful contacts in Texas and federal legislative circles, I’d love to talk with them too.

We don’t know how this next part works. We’ve never done politics before.

But we know self-employed people need our help.

We’ll do all we can to be back to serve them soon.