Harminder Singh, a taxi driver who's worked nights in New York City since 2001, says he knew the job was making him sick.

He felt fit enough, even as a diabetic in his 50s, to heave luggage out of his trunk and onto the sidewalk. But a few years ago, his blood pressure started rising, and he started to feel weakness in his right arm. A doctor told him that his kidneys were beginning to fail, and that he should take it easy.

"He said, 'You know your work is no good, I think this is coming from your job,'" Singh says. "But I cannot stay home, because I got to do something." So he kept driving to support his wife and two sons -- up until this February, when things got bad enough that his doctor told him he'd have to go into the hospital within the next couple of days. He's been on dialysis three days a week since, and is still too weak to drive safely.

Medicare covers Singh's medical bills. But because he's an independent operator who leases a taxi medallion from an individual owner, he doesn't have disability insurance, which would compensate for his lost income. Since he'll be disabled for a long time, he's applied for Social Security benefits, and the request is still pending. So now, he has no way to pay the $1,400 rent on his apartment in Richmond Hill, Queens, other than the kindness of friends.

"I need help right away," says Singh, a tall, lean man who now moves cautiously, slowly. "I don't know how long they are going to take."

Until late last week, help seemed close. In 2012, the city's Taxi and Limousine Commission had voted to take six cents on every fare for a fund that would help with exactly these kinds of situations, providing upwards of $300 per week in assistance as soon as a driver could produce a doctor's note. The money started flowing in February, and Singh was just waiting for newly installed Mayor Bill DeBlasio to greenlight a contract for the fund's administrator, who could then begin doling out cash.

And then, on Friday, Singh's hopes fizzled: A New York State Supreme Court judge struck down the TLC's rule, in a decision that may limit how independent workers -- who are exposed to the most economic risk and enjoy the fewest legal protections -- can collectively organize for benefits that are otherwise beyond their reach.

To understand the implications here, you need a little backstory. The health-care fund is a direct outgrowth of pressure by the New York Taxi Workers Alliance, a 16-year-old group that claims 17,000 out of the city's 50,000 registered drivers as dues-paying members. The Alliance estimates that about half of New York City's taxi drivers don't have health insurance, since there's no employer to provide it, and projected that many wouldn't be able to afford even the plans offered on an exchange when the Affordable Care Act went into effect.

So the fund is designed to fill in the gaps: Along with prompt disability payments, it contracts with a group of vendors to provide dental and vision coverage, mental health counseling, a 24-hour physician hotline, a small life insurance policy, and help with problems that come specifically from driving 12 hours a day, like back and neck pain. That would allow drivers to opt for the most basic plans available, and let the fund cover the rest.

There's at least one example of contractors organizing to buy health insurance: The Freelancer's Union, which started offering plans before Obamacare took effect. But the approach of creating a communal benefits pool to supplement commercial plans by levying independent workers in a regulated industry is actually unique, and an example of how alternative labor groups can provide services for people who aren't represented by traditional unions. The New York Taxi Workers Alliance also won the contract to administer the fund, and executive director Bhairavi Desai says cities like Philadelphia and Chicago were interested in the model as well.

"I just think that the fund would begin to change the dynamic," says Desai. "I think it could be the first institution that would really put labor at the table in a significant way."

The court decision is a serious blow, and makes several assumptions. In her nine-page decision, Judge Margaret Chan writes that "if obtaining health insurance is the goal here," the Affordable Care Act contains provisions that would perform the same functions proposed by the taxi workers' fund. But as outlined by Desai, the fund is mainly meant to supplement health insurance with services that otherwise make plans cost more. Also, Chan cites the American Association of People with Disabilities to argue that Obamacare already provides disability insurance, which isn't true -- it only bans discrimination on the basis of a disability in selling health insurance, but doesn't replace someone's income in the event that he becomes disabled.

"To me, it was just such a hateful decision," Desai says. "It's really missing the point of the program."

A TLC spokesman says the agency is still considering whether to appeal the ruling. In the meantime, Singh is gathering documents for his Medicaid appointment next month, which will decide whether he gets food stamps, and waiting on a decision from the Social Security office.

"I like to work, because I'm very strong. But this is not an excuse -- I am really helpless," Singh says. He hasn't been able to build up any savings over 13 years of driving, earning $800 on his good weeks, and is grateful that medical bills are taken care of. "But what about the house?" he asks. "How can you survive yourself? This is the big question."