Earlier this week, the developers of Dwarf Fortress revealed that having spent more than 16 years developing their game for free, relying almost entirely on donations from the community, they would be releasing a premium version of the game on Steam and Itch.io. Citing the “uncertain structure” of their current system and personal health issues, Tarn and Zach Adams decided it was time to stabilise their income.

Development on Dwarf Fortress began in 2002, and an alpha version was released four years later. In an interview, Tarn Adams told us that for the following nine years – from 2006 to 2015 – “our numbers wobbled wildly from month to month, as they mostly depended on one-time PayPal contributions, and those tend to happen more around releases and news events.”

In mid-2015, the brothers signed up for Patreon “and it didn’t take very long before a majority of our income was coming from there instead.” That was an improvement on the previous situation, as the online tip jar allowed for more continuous monthly donations, but didn’t solve everything.

Patreon quickly became “something like 3/4ths” of the developers’ monthly income, “which makes us susceptible to any hiccups or changes in policy, and we don’t really have a lot of cushion if there are delays in pay-outs and that kind of thing.” Tarn acknowledges that these are issues faced by all businesses, but referenced comments from Patreon CEO Jack Conte’s. Earlier this year, he heavily implied that the company’s business model wasn’t sustainable, and might be forced to change in coming years.

Concerns around Patreon were compounded by issues attached to ongoing healthcare costs. In a recent announcement, Tarn said that “for many years, Zach has been on expensive medication.” While that’s covered by insurance, “it’s a source of constant concern, as the plan has changed a few times and as the political environment has shifted.” He went on to say that between ongoing treatment, other family health issues, and his own insurance plan, “I’d be wiped out if I had to undergo the same procedures.” None of that impacts the day-to-day development of Dwarf Fortress, but it has shaped the decision to release the game on new platforms and open up new revenue streams.

Related: Here are the best strategy games on PC

There are problems beyond healthcare to contend with, of course. Valve has come under fire over the cut it takes from developers and the ease of discoverability on its platform. Tarn acknowledges that Steam’s 30% sales cut is thought by many in the industry to be quite high, but hopes that the community around Dwarf Fortress will help circumvent those issues.

It's not just the indie scene, or the entire game industry. It's almost everybody

Not every developer is fortunate enough to have that kind of community rally around their games, however. When I asked whether indie development as a whole suffers as a result of problems surrounding health insurance, Tarn said “it’s not just the indie development scene, or the entire game industry, it’s almost everybody. The healthcare system in the US is broken.”

As a game developer rather than a policy maker, Tarn isn’t overly willing to put forward a potential solution, pointing out that his situation is different to many others. “Having given away games for free for 18 years subsisting entirely on a tip jar for 12 of them, I’d suggest universal healthcare and [Universal Basic Incomes] and unions and all that, but that’s a selfish fit to my desired lifestyle, working on projects non-stop in a sparse room like some kind of games monk. Still, something’s gotta give. Something just did I guess, and now we’re going to make the best of it.”