Recent economic trends nationally and in Iowa include the proliferation of Uber contract-driver taxi services and owner-operated food trucks. Both of these services rely on individuals starting a small private business in the competitive world of commerce.

My brother, my father, and my grandfather have all been owners of their own small businesses. The gumption and personal sacrifices needed to take on all the requirements necessary to run a successful small business have always humbled me. From advertising and marketing to hiring and personnel management, to municipal, state and federal regulations, to eventual retirement, a small-business person needs to consider every aspect of their business. Despite this, many individuals crave the freedom and independence that running their own businesses or being independent contractors allows. Given the other options of being someone else’s employee in a large business or a government worker, I sympathize with and support individuals who are willing to risk their time, resources, and self in these challenging endeavors.

Unless a small-business owner or freelancer is independently wealthy, one of the primary barriers for these new entrepreneurs is health insurance, which for many of these individuals makes the health insurance Exchanges critically important. The current status of health insurance — with significant premium increases, higher deductibles and copays, and fewer plan options from which to choose because of insurers leaving the health Exchanges — makes these people’s situation more tenuous.

The difference in what these small businesses and independent contractors have to do to navigate the health-care insurance system is daunting, especially when I consider my patients who work for Iowa State University. The difference reminds me of one of my favorite patients, who, at the age of 65, retired as a janitorial worker at Iowa State. She retired with good retirement benefits and was happy and content. Since her retirement, I have seen her and enjoyed hearing her positive experiences with retirement. In this world of outsourcing and fewer benefits for individuals working at jobs such as janitors, I am sure many janitors in the United States would not be able to retire at 65 as my patient did. It is this contrast between the benefits — be it retirement benefits, on-site child care, or health insurance — that government and major corporations can offer their employees compared with what is available to small-business persons or independent contractors that I continually rail against.

In the few years since the enactment of the Affordable Care Act (ACA), I sense two economic orbs rapidly moving away from each other. On one hand, with independent professionals such as Uber drivers, food-truck operators, and microbrewers, we see more and more people choosing a small-business or independent-contractor approach. Yet the individual health-insurance orb seems to be moving headlong toward higher premiums and higher deductibles and copays with fewer and fewer choices in the marketplace.

The presidential and congressional elections will decide the course of the nation for the next four years for many essential elements of American life, including health-care coverage. Either tweaking the existing ACA or totally replacing it will be a necessary task for the next Congress and president. Many years ago, our country wisely created Social Security and Medicare. Both are celebrated examples of economic protection for our citizens. The ACA was created as another mechanism for economic and health protection for Americans. It has dramatically helped millions of American, but I firmly believe it must be, just as Social Security and Medicare were, adapted over time. For individuals driving Uber taxis and operating food trucks, if we do not change the course of the ACA, they will not have health-care coverage in the future. This blog is dedicated to preventing that future.

I look forward to working to create a different and better future after the November elections. Who you vote for is a personal choice, but your vote will have a profound impact on the future health care of many, many Americans.