In health care reform, where's the heart for artists?

In the first of two parts, Dollar Store Dilettante columnist Steven Kent tackles the issue of health care reform as it relates to college students struggling in the employment market, often tackling several part-time jobs.

With the recent passage of President Obama's health care bill, Americans have begun discussing the holes in the nation's health care system like never before. And yet, despite the national studies showing that 30% of professional artists living in major cities lack health insurance, and that 43% of the artists who do have coverage are in danger of losing it, it still seems like that great debate often devolves into talk of right vs. left, or rich vs. poor -- and fails to address the ongoing battle of art versus health.

So what does the new health care reform bill mean for students of the arts and self-employed, working artists? In order to get some perspective, I did some research and talked with Narric Rome, Federal Director of Affairs for the Washington, D.C.-based non-profit Americans For The Arts, who has spent most of his career lobbying legislators for artists' interests. He agreed that one of working artists' and writers' greatest challenges lies in the fact that their hard work often leaves them at the margins of the system when it comes to conventional health insurance options.

"A teacher can work for ten months and get twelve months-worth of health insurance from their employer," he said, "but a working artist will often pull ten months of full-time work at four different jobs. It's comparable work, sometimes even in terms of pay, but it works out totally different in how they acquire health insurance."

As a journalist, freelance writer and recent college grad, I can certainly relate. The newspaper industry isn't exactly handing out full-time jobs these days, and the issue of health coverage alone relegates me to my day job slinging cafe lattes.

Still, at least I can imagine some Utopian dreamland where I land a full-time job doing what I love with a company large enough to offer me a decent health care plan. For most artists, musicians and writers, whose talents and corresponding careers often necessitate self-employment or a position with a tiny institution, that dream exists completely at odds with the way that most Americans acquire quality health insurance.

"Artists and writers aren't necessarily victims," Rome said, "but it just so happens that they're in a group that doesn't get comparable health care when compared to pretty much any other white-collar industry."

Although Americans For The Arts formally lobbied for the "public option" that existed in the President's original proposal as the best way to extend health coverage to working artists, that provision never made it to the final bill. Still, Rome highlighted a few other aspects of the bill that might mean a great deal to creative types who find themselves self-employed or hopping between part-time gigs after college (and beyond).

What's A Health Exchange, Anyway?

One of the most important caveats about the health care bill as it relates to the self-employed is its mandate for universal coverage. Starting in 2014, artists and writers who support themselves on their work alone (along with most other uninsured people) will need to purchase some form of health coverage, or cough up tax penalties that start at $695 per year and continue to climb over time.

One of the coldest facts about the health care industry -- and one of the most well-documented -- is that the process of shopping for individual health insurance on the open market, put simply, sucks. It stands to reason, then, that being forced to do so could hurt those working artists and writers affected here. However, there's a potential upshot in that the bill calls for states to establish official "health exchanges" where consumers can shop for policies that meet state and federal standards.

How is this different than going online today and shopping for your own policy? Most policies that you'll find that way prove wildly more expensive than what a large employer would charge you for similar coverage, simply because big companies can group together their employees and negotiate a cheaper rate by offering lots of (mostly healthy) customers in order to spread the risk of illness over that pool. The health care exchanges would treat shoppers who use them as a similar co-operative pool, and negotiate that cheaper rate for the consumer in advance, just like employers do.

The mechanics of how this will work are way beyond the scope of this column (and no one knows exactly quite what it will look like yet anyway), but you can find a more in-depth explanation in the excellent health care reform special at the Christian Science Monitor, and in posts by other WalletPop health care experts.

Rome said he holds some hope for these exchanges as a meaningful option for the self-employed, but noted that working artists and writers still face different challenges than other professionals, even when it comes to the new options in President Obama's health care bill.

"We're talking about a community that's very seasonal, that moves around a lot," Rome said. "Can they find health care [on an exchange] in New York if they just moved from Chicago? These are the things we're concerned about."

"This [bill] is only ten days old," he added. "It's still in a complete state of infancy, and even for an expert, it's hard to say exactly how all of this will play out."

Medicaid Expands

Another aspect of the bill that might make a big difference in the lives of recent art-school grads and aspiring writers is its expansion of Medicaid, the federally-funded public health-insurance program for low-income individuals and families. Current Medicaid eligibility guidelines vary from state to state, and often prove fairly Byzantine in their exact requirements, but starting in 2014, the new bill streamlines the requirements and raises the income cap for Medicaid to 133 percent of the federal poverty level ($10,400 a year for an individual in 2009), as well as providing a boost to the reimbursements Medicaid offers to doctors and institutions who accept it.

"I see that number go up," Rome said of the 133-percent income cap, "and I think -- and it sounds like such a cliché -- but I think that it will allow for struggling artists just beginning their careers to find a new health care coverage option that wasn't there before."

Never imagined yourself on the equivalent of health-care welfare? It might be time for an ego check. I come from a middle-class background and graduated with honors from an expensive private university, but my income in my first year out of college as a barista-cum-freelance-writer (2009-2010) clocked in at only $12,137, which means I would wind up eligible for Medicaid under the new bill. (w00t, I guess.)

Check back for more of my discussion with Narric Rome and a breakdown of other changes in the health care bill that might affect the lives of creative professionals in part 2 of this article.

Steven Kent is the Dollar Store Dilettante, a blasé lad who knows more about saving a buck and stoking his hipster credentials than all his editors combined. His Money College column runs Sundays; send your tips and best MP3s of Pitchfork bands to Steven at MoneyCollege@walletpop.com.

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