What drove Venus Williams to the court at the Mubadala Citi DC Open this week after a year-long break from competition?
"I had to come back for the insurance," she quipped in an on-court interview after winning her first-round match on Tuesday. "I was like, 'I got to get my benefits on!' Started training."
The crowd at the stadium in D.C. laughed knowingly. "You guys know what it's like!" she said.
Even if you're not a seven-time grand slam champion who just became the oldest player to win a pro women's singles match in decades, you probably know the job-health insurance juggle that Williams was talking about.
Here are four ways U.S. health insurance can be challenging for Williams and many other Americans.
1. Her job is a little off and on.
In the U.S., most working-age people get their health insurance through work. Their employer gives them a few plan options and then pays a healthy chunk of the premium cost, with the rest deducted from employees' paychecks.
When someone leaves a regular job maybe to start a business or take a break, there goes that health insurance deal. That's essentially what happened to Williams — she took a break from competition and lost access to her regular benefits.
The health insurance Venus Williams got through the Women's Tennis Association was a "best-in-class global medical, dental and vision insurance plan," WTA wrote in a statement to NPR. In order to be eligible, players have to have a certain ranking and play a certain number of events in the previous year, according to the statement, and coverage lasts for the full calendar year.
"They informed me earlier this year I'm on COBRA," Williams explained on the court Tuesday. COBRA is a law that allows you to keep your job-based insurance plan after your job ends, but you have to pay for the whole premium yourself.
"With COBRA, you may have a very good plan, but your health care costs are going to go up," explains Miranda Yaver, health policy professor at the University of Pittsburgh. It's notoriously expensive, often $500 per month or more. COBRA to cover a whole family's insurance premium can easily rival a mortgage payment.
Venus Williams is a multi-millionaire, so the premium cost might not matter to her in the same way it does to the average person, especially if it allows her to keep that "best-in-class" plan she's used to.
2. She has health care needs.
"Let me tell you, I'm always at the doctor, so I need this insurance," Williams said in her courtside interview.
Williams recently explained she had surgery for uterine fibroids that had gone undertreated for years, she said. She also was diagnosed with an auto-immune condition called Sjogren's syndrome in 2011.
She's also an elite athlete. "Someone in her position might need physical therapy, sports, medicine, specialized care, and to be able to get that anywhere in the world," says Cynthia Cox, a vice president at the health research organization KFF.
Plus, Williams is now 45 years old. Health insurance costs generally increase with age, as do health problems.
All of that could make finding a health plan that works for her more complicated than for most people.
3. She has way more options than she used to.
Before the Affordable Care Act, Venus Williams would have really been in a tough spot.
Professional athletes were included on a list of "Ineligible Occupations" — jobs that health insurance companies deemed too risky to provide coverage for — along with loggers, miners and taxi cab drivers.
Also back then, "even a wealthy person might have had preexisting conditions that could have made them uninsurable no matter how much money they were willing to pay for their premium," Cox says.
That contributed to "job lock" — where people were stuck in their jobs no matter what because they needed the health insurance.
Now, if Williams really didn't want to compete anymore and ran out of her 18-months of COBRA coverage, she could go to Healthcare.gov and buy an Affordable Care Act plan.
4. Only in the U.S., jobs and health insurance are deeply linked.
There's no escaping the fact that in America, health insurance is connected to employment. "The dominant insurance model in the United States is employer-sponsored insurance," Yaver says. (The story of how that came to be is related to the post-World War II economy when health insurance was a "fringe benefit," to attract employees in a tight labor market.) Yaver adds that for workers who get insurance from their jobs, it's often "a good deal."
Since Congress passed the One Big Beautiful Bill Act, the public insurance plan for low-income people, Medicaid, will soon be tied to work, too. Beneficiaries will have to periodically prove they're working a certain number of hours per month to be able to keep their health benefits. That requirement will affect mostly middle-aged, low-income women, according to a recent analysis.
For Venus Williams, the off-and-on nature of her job that comes with a high risk of injuries makes employer-based health insurance especially hard. In a way, the tennis hall-of-famer is dealing with a very special version of "job lock."
Her fans can celebrate, though. Even if it's for the health insurance, they get to see her on the court again; she's playing a tournament next month in Cincinnati.
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