Andrew Scharff doesn't clown around when it comes to taking care of his health. Scharff, who works as a professional clown, has needed health insurance for most of his life to monitor his asthma, eczema, and dozens of allergies, and he currently reaps the benefits of the ACA.

Like many young adults, in his early twenties, Scharff chose not to pay for health insurance. Although uncertain about the future of his health conditions, it didn't seem worth it to Scharff to pay the premiums. He was busy building his career as a clown, working contracts of varying lengths and for different companies, including Ringling Brothers and Barnum & Bailey Circus, which will hold its last show this May, after 146 years of performances.

In his later twenties, Scharff realized he needed health coverage and briefly "shopped around" for insurance. He selected a policy with a $100 monthly premium, but that rate didn't last long. Each year, Scharff's premium increased, untethered to his income, eventually capping at $340 per month. While performing a show outside Pennsylvania, Scharff sought medical attention and soon discovered that his $340 per month plan did not cover any health care provided outside the state of Pennsylvania.

Travelling internationally as a clown performer on cruise ships for up to thirteen months at a time, Scharff eventually dropped his health insurance coverage, as the cruise ships offered free health care for employees. Between cruise ship contracts, Scharff went without health insurance, again living in uncertainty and hoping to avoid medical mishaps that could lead to financial ruin.

When Scharff returned to his South Philadelphia home in 2015, he signed up for the Affordable Care Act. Although his monthly premium was higher than $100, he was relieved that it was costing him significantly less than his peak-insurance premium of $340.

And he was certainly grateful for the ACA. In addition to performing hometown gigs at Spruce Street Harbor Park, the Fourth of July celebrations at Independence Hall, and Democratic National Convention events, Scharff spent two months spreading laughter to children in orphanages across Central America through his project "Clown the World." Having ACA coverage, Scharff was able to visit with a South Philadelphia-based physician before his backpack-based traveling circus.

Most recently, though, Scharff found himself particularly grateful for health insurance coverage. While flying into Newark, NJ, Scharff fainted in the aisle of the airplane, resulting in a cut to his chin that required stitches. What he anticipated as a short ER visit quickly turned into an overnight hospital stay as healthcare providers investigated the reason for his fall. His hospital bill, before insurance, was $10,000. With ACA coverage, Scharff paid $200.  His realization: "It was nice to not have this stupid little thing ruin your life."

Even better, because he spent so much time performing free shows for the children in Central America, Scharff learned that his monthly premium for 2017 was reduced because of his lower annual income. "I think it is great that it is flexible like that, you pay more when you make more, you pay less when you make less."

The ACA has provided many self-employed Americans with "unconventional jobs" health coverage assurances that they fear will be taken away through looming ACA repeal. "It's nice," Scharff noted, "to be able to be self-employed and do a variety of different things; to take time off to do Clown the World, to go and be an employee on a cruise ship for a year, and know that when you return you have an option for health coverage at home."

For Scharff, a South Philly guy turned traveling clown, the importance of affordable health insurance coverage is no laughing matter.


Mara Smith is a third-year student at Drexel University's Kline School of Law concentrating in health law.


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