How Health Care Reform Affects Musicians and Other Artists

Related Stories

• Why Cuban Dissidents Aren’t the Future of Cuba
• Facebook Won’t Show You Pot Leaves but Risque Photos and Holocaust Denial Are Fine
• 50 Cent Says His Twitter Account is for Adults Only but Is That Possible?
• The Street Harassment Problem
• Weekly Pulse: Stem Cell Hell, Bad Eggs, and DIY Abortions

During the push for health care reform, House Speaker Nancy Pelosi asked MSNBC host Rachel Maddow to visualize “an economy where people could be an artist or a photographer or a writer without worrying about keeping their day job in order to have health insurance.” But how, exactly, that might happen was unclear. Just days earlier, Pelosi had said, “We have to pass the bill so that you can find out what is in it.”

As it happens, a panel convened at the Future of Music Coalition D.C. Policy Day conference at the New America Foundation on Tuesday to answer whether artists could in fact finally quit their day jobs now that health care reform has passed. The panel’s answer: We still have to find out what’s in the bill.

Musicians have good reason to ask. According to a March 2010 survey of 1,450 musicians conducted by the Future of Music Coalition, some 33 percent reported that they were uninsured. While this is an improvement over a similar study conducted in 2002, when 44 percent of musicians reported that they did not have health insurance, the uninsured rate among musicians is still more than twice the rate among nonelderly Americans (15 percent), reported by the Kaiser Family Foundation in 2008.

The panelists—Adam Huttler, executive director of Fractured Atlas, a national nonprofit that provides insurance support services to independent artists; Alex Maiolo, program coordinator for the Future of Music Coalition’s Health Insurance Navigation Tool (HINT) program; and Renata Marinaro, Health Services Education and Outreach manager for the Actors’ Fund—all work to answer health insurance questions for musicians. Future of Music Coalition education director Kristin Thomson, who served as the panel’s moderator, says that the survey found that the higher the percentage of income derived from performing, the more likely the respondent was to be uninsured.

“I don’t honestly know what’s going to happen over the next few years, as to how it will affect what we do,” Huttler says. Fractured Atlas works to enroll artists in health insurance plans, primarily low-cost, high-deductible health insurance packages often paired with health savings accounts. For 32 states, Fractured Atlas has partnered with Aetna to provide individual preferred partner organization (PPO) plans. While these plans cost no less than the Aetna PPO plan an individual could buy on her own, Fractured Atlas provides additional one-on-one assistance for artists navigating their health coverage options.

Increasingly, Huttler explains, advocacy and education are a significant part of his job description. “I’m a licensed insurance agent and sometimes I have to look at plan details two or three times before it becomes sensible. There’s a built-in obfuscation in the system so that, what? So the man can keep us down?” he says. “No, there’s no reason this stuff should be complicated.”

“For the last few years, HINT has been telling people why they should get health insurance,” says Maiolo, whose organization provides artists with a hotline for answering insurance conundrums. “Now everyone has to. Our roll will become increasingly, ‘What does all of this mean?’”

Marinaro, a social worker who has worked in the health-care industry, explains how the health-care timeline would affect the music industry—to the best of her ability. “I have a disclaimer: Parts of this law are still ambiguous and still being written,” she cautions. As of June 21, she notes, individuals with pre-existing conditions who have been uninsured for 6 months or more will be able to buy coverage through a national, temporary, high-risk pool. The high-risk pool would limit out-of-pocket spending to roughly $6,000 per year and would cover at least 65 percent of costs.

But with the rollout date on the high-risk pool less than a month away, there are still no details available as to how the high-risk pool will actually work. “That is, for us, the biggest question mark,” she says.

The early rollout still features many of the problems that health care reform seeks to correct. “This [high-risk pool] is good for people who don’t have any insurance right now and might have a chronic condition that isn’t being treated,” Marinaro explains. One person who called her—a lung-cancer patient—had insurance that was running out due to an annual cap. This individual cannot afford losing coverage for 6 months just to qualify for the national high-risk pool, but he or she also cannot buy insurance on the open market due to a pre-existing condition—which will not be outlawed until 2014. “For some people, this high-risk pool is going to be a great thing. But it’s not necessarily for everyone.”

On Sept. 23, the health care bill will enable young adults under age 26 to appear on their parents’ health care plans. (Even then, students may face a gap in coverage between the date they graduate and the next open-enrollment period for their parents’ insurance plans.) And as of 2014, uninsured individuals will be required to purchase one of five plans through state-run exchanges, including bronze, silver, gold, and platinum coverage plans as well as a catastrophic-coverage plan for “young invincibles” under the age of 30. Both of these features that target young adults could benefit young musicians.

The catastrophic plan features a high deductible—roughly $6,000 per year, after which coverage will most likely be 100 percent. Some have argued that a high-deductable for young people isn’t good for young people because it doesn’t cover basic care or prescriptions for some 15 percent of young people who already have a chronic conditions and young women in particular who use basic care more often. But the high deductible suits Huttler and Maiolo just fine.

“We back high-deductible plans, for better or worse,” explains Maiolo. Huttler concurs and says that Fractured Atlas advises artists who are typically young, incur few health costs, and hope primarily to safeguard against catastrophic loss. He tells them to pick the figure for out-of-pocket annual expenses that they could survive over years of chemotherapy—and to choose for co-pay and prescription drug costs as a secondary consideration. “That basic philosophy of picking out a health care plan is not going to change when this wonderful legislation rolls out.”

Huttler says that musicians can endure high deductibles. “One of the benefits to being a musician over an accountant is that accountants don’t often hold benefit concerts when one of their own goes down,” he says. For example, a series of benefit shows recently raised $16,000 for one sick musician—a drop in the bucket compared to his overwhelming medical bills. “If he had had that stop-loss, that benefit would have taken care of two years of those costs.”

Maiolo fears that the high-deductible plans they advise for artists might not make the cut in the exchange. These plans might not meet the minimum benefit requirements, which have not yet been fully specified. Maiolo and Huttler both recommend artists consider health-savings accounts—essentially, an escrow account that individuals may pay into tax free and then use to cover costs associated with dental care, alternative or holistic treatments, and other health care not covered by their insurance benefits. Health savings accounts only come with high-deductible plans. Marinaro adds that over-the-counter medication will not be covered under health savings accounts in the future.

“We’re not becoming communists next week,” argues Huttler. “We did not get national health care. When confronted with the problem of national health care, we came up with the solution, ‘Make them buy health care.’ It’s like telling people who are hungry that they should get something to eat.”

The panel touched on some of the more familiar arguments taking shape around health care: Whether premiums will rise because children age 26 and under will be added to their parents’ plans or whether premiums will fall due to a larger, healthy pool and lower administrative costs. Marinaro said that health care after reform will still be quite expensive for artists. What the government considers affordable insurance is 8 percent of income, she explains, and while the government will subsidize people making up to 400 percent of the poverty level, or $43,320 a year for a single musician, that 8 percent is still “quite a chunk of change.”

Huttler says he hopes that Fractured Atlas will qualify as a “navigator” for the exchange: A still-amorphous category that will be eligible to receive state grants for steering people toward their health care mandates. And Maiolo says he expects that the standardization of health care (under the bronze, silver, gold, platinum, and catastrophic plans) will in fact make the entire system easier to navigate. There is hope for independent consumers—like musicians—who struggle with the complexity of the thing.

But the exchange leaves many unanswered questions. How will it affect the Washington, D.C.,-based hardcore drummer who gets hurt while playing the Red 7 in Austin, seeks emergency care under his PPO, and is then denied coverage for any further hospital stay? Will a new monthly bill—and a potentially high monthly bill at that—have a chilling effect on touring, when income and access to mail (and to health care) is irregular? The panelists agree that national health care will mean fewer artists suffering health care-inspired bankruptcies. But until 2014 at the earliest, health care reform is unlikely to bring real relief to a class of people who have gone without any for a long time.