The ACA is a big deal, for a lot of reasons. It’s not perfect, but personally, I think it’s a great start to creating a society that actually stands by one of it’s primary ideals – “Life, Liberty, and the Pursuit of Happiness,” by ensuring we can get through the “life” part.
For the past several years, I’ve been lucky enough to live in a liberal state that provides a lot of subsidies for health care anyway. As a woman who has not made more than $20,000 a year since graduating in 2006, I’ve had my reproductive care almost completely covered by the state (the one exception was when I had an HPV scare a few years back, and had to get pap smears every 6 months for a year and a half. On my Medicaid coverage, I could only get one free per year, so I had to fork out for a second one. But, to ensure I was not going to die of cervical cancer, I think that’s not a bad deal). There are sliding scale clinics I’ve visited to take care of various illnesses. I haven’t been to one, but I know there are sliding scale dental clinics. Costco offers a flat $100 rate for eye exams to anyone, without being a Costco member (you still have to get glasses and contacts elsewhere, but if you just need an eye exam, not bad).
When I lived in South Carolina, I didn’t know that these options were available. Washington State makes a point of having all of these options visible – I’ve seen bus ads for state medical services of all kinds. But in a more conservative state, not only are funds cut, ignorance is perpetuated. My mother, who still lives in the south, has suffered some medical problems recently and has had to be very forceful to get clear and complete answers to her questions. While there is an opt-out option for states (preserving states’ rights, donchya know), and I suspect South Carolina will be one of those states, I think the ACA will overall set a higher standard for coverage, care, and information available for everyone.
That said, some of the ACA’s potential failings: it still costs money. There’s essentially a stock market for health insurance being set up so that companies can compete, and consumers can in theory get lower-cost insurance. Now, lower cost is not strictly universal health care. It is an attempt to lower the overall costs, but I think there’s so many loopholes in current monopoly laws and anti-trust laws that I don’t personally think this is going to help anything. I don’t see how it is significantly different from the current individual payer market.
However, the expansion of Medicare and Medicaid will very much help artists. Playbill.com has published an online article about the ACA – “Affordable Care Act to Be a Boon to Performing Arts Workers” by Robert Simonson – which discusses how this will specifically help low income people, which is a category the cast majority of working artists fall into.
The federal program will benefit actors in a variety of ways. In the most basic respect, insurance seekers will no longer be on their own. “The ACA allows the individual to be in the small group market,” explained [Jim Brown, National Director of Health Services at the Actors Fund]. “They get the benefits of being part of a group. The law will by 2014 set up something called Exchanges, which are competitive marketplaces. These Exchanges will be multi-state. They’ll be able to pick a plan from these Exchanges. Private insurers will compete. More people will buy it—people who couldn’t afford it before—because their premiums will be subsidized.”
Under Federal law, the official poverty level is currently just over $11,000 a year. Brown said he deals with a lot of theatre people who make between $25,000 and $45,000 a year. Under the ACA, people making under 400% of Federal poverty level—under $44,000—will now qualify for insurance premiums that are subsidized through tax credits, lower premiums and lower out-of-pocket costs. Also, “No one will be forced to pay more than eight percent of their income in health insurance,” added Brown. “Essentially, they’re defining what affordable health care is. It’s why it’s called the Affordable Care Act. It’s really about the cost of insurance and bringing that cost down.”
The law will also adjust the level at which suffering workers can qualify for Medicaid—something that will help actors get through a rough patch.
“We have people in this industry who have a bad year and their income drops precipitously,” explained Brown. “Some of these people will now be eligible for Medicaid, because the law raises the eligibility for Medicaid around the country to 133% of the Federal poverty level. This is a huge change. In New York right now, your income would have to be below 78% of the Federal poverty level. You’d have to be really making about $8,500 a year. This will bring up the income level. This will be around the country, and it’ll include actors who, because of the episodic nature of their work, have a bad year.”
The article also addresses one of the major failings of artist unions – health insurance cost.
Actors can get affordable insurance through their unions, but only after having worked a certain number of weeks a year. If, as is the case with many union members, they don’t meet that criterion, they have to fend for themselves. The least-expensive HMO currently available in New York City, said Brown, comes from HIP. It costs a whopping $920 a month. As for those who attain union insurance, but then lose it when they fall into unemployment, they can take advantage of COBRA to hold on to their benefits, but at a cost of $600 or $700 a month.
Now, there are companies out there, like Fractured Atlas and Actors Fund, who provide services explaining what social services are available (through the state or through a union) and also provide some kind of funding or service to help artists who do not have health insurance. But because of the cost, the coverage is often not as comprehensive as coverage offered through for-profit businesses. This has caused problems for artists who want to focus on their freelance work, but have to choose between physical security and, well, pursuit of happiness. This law will help artists make a transition between working part time on their career, and moving to full time freelance work, with the knowledge that they are safe in event of a bike accident or cancer. This is a nice bridge, as other safety nets (like midsized theatres) have been disappearing in the past 20-30 years.
So, overall, I look forward to seeing what the ACA can do for me, and how it affects my life. I know several freelance writers, musicians, and theatre artists as well, and I hope that we all can benefit from this coverage.