Sarah Gardner: Building a Business, Bracing for the Insurance Bill

30-year-old Sarah Gardner lives in Lisbon, Maine, with her nine-year-old daughter, Olivia. After years of working in restaurants and taking on temporary nine-to-five jobs, in January 2025, she launched her own business, Quintessence Photography. That decision to become self-employed reshaped how she accesses health care and put her on a path she is still trying to understand.

Right now, Sarah and Olivia are both covered through MaineCare. As a new business owner, she is permitted to report a loss for her first two years, because she is not yet expected to turn a profit. “So, because of that, on paper and in reality, I don’t make the minimum,” she said. That has qualified her for MaineCare, something she says she is deeply grateful for. “I’m very thankful for that because it’s very hard to get.” She credits a helpful state employee for walking her through the process. “I actually didn’t know those stipulations. I was able to talk to someone at the state and they were helpful.”

But that coverage will not last forever. “What happens when I do start turning that profit?” she asks. Sarah expects she will eventually need to elect S Corp status for her business, which would allow her to pay herself as an employee and purchase insurance in a more formal way. However, the cost is daunting. “It’s still money coming out of my business every month. That’s going to be like $800, plus it’s gone up now. So, it’s probably going to be way more than that to insure my daughter and I through the business.” She knows it will cut into her profits. “Right now, logistically, I don’t know how that’s going to work.”

Sarah’s history with insurance has been anything but steady. Before starting her business, while working as a bartender and restaurant manager, she made too much to qualify for MaineCare but still struggled to get by. She bought coverage through the marketplace instead, paying premiums of $700 to $900 a month. “That was not really sustainable,” she said. “I was always behind on my payments, basically.” Even that expensive coverage fell short of her health needs. Her ADHD medication, which she relies on to function, cost her over $100 a month under that private plan. Under MaineCare, her three prescriptions cost about $6 a month combined. Olivia’s asthma and allergy medications are free through MaineCare as well; without that coverage, Sarah said the family would be forced to make painful trade-offs. “Would not be able to do that. I would quite literally be going without something else, like paying a late mortgage, not paying electricity to make that happen.”

Sarah has learned to navigate MaineCare’s paperwork and renewal requirements largely through trial and error, with help from other single mothers who showed her the ropes. “I think just literacy and knowledge around accessing health care is really wanting,” she said. “I’ve had to do a lot of my own digging and trial and error and hours and hours on the phone with support to figure it out.”

Sarah has fortunately not accumulated medical debt, something she attributes to family support. When Olivia was born, Sarah was 20 and still covered under her parents’ insurance, and her father had quality coverage through his job that helped take care of the costs. But that does not mean she hasn’t faced painful medical bills. During a period when Olivia was on Sarah’s private insurance rather than MaineCare, Olivia’s doctor told them she needed an adenoidectomy, surgical procedure to remove the adenoid glands located behind the nose. “I think I paid like $3,000 out of pocket after insurance for a necessary surgery that the doctor told us we had to have,” Sarah said.

Even with insurance, cost has shaped Sarah’s decisions about care. Before accessing coverage through MaineCare, Sarah was receiving premium tax credits while on a marketplace plan, sharing, “I wouldn’t have been able to access health care without it.” Still, she avoided routine visits. “Even when I had that good insurance, through the marketplace, I would still avoid going to the doctor for anything beyond a physical, because I’d be paying at least $60, which I didn’t have.” Today, even though they are covered, neither she nor Olivia have dental included in that coverage, as it would be an added cost of about $300 a month that the family cannot spare.

Looking ahead, Sarah wants policymakers to understand what it takes to build a small business while trying to stay covered. She appreciates Maine’s two-year allowance for reporting losses, but still wonders what comes next. She sees a gap between what counts as enough income on paper and what it actually takes to get by. “The gap between the minimum requirements of income and like a living wage is so wide now that, like I said, you can be making like enough on paper to not get MaineCare, but you can’t even make ends meet, let alone make your insurance premiums.”

For Sarah, the fix starts with priorities. “We need health care to be accessible and affordable, and we need to put people first instead of profits from the corporations and the hospitals, because at the end of the day, hospitals are corporations in this country, and they should be treated as such.”