Chapel Hills Lynn Blakey is 51 years old and a professional musician which means that, for most of her adult life, shes not had health insurance.
Blakey had coverage for several years after college, through a job at Music Loft in Carrboro. But shes done without it since the mid-1980s while playing guitar and singing in acclaimed yet not terribly commercial bands including 80s college-radio stars Lets Active and country-folk group Tres Chicas.
Music, restaurant and child care work added up to a living, though not enough of one for her to afford the routine health care that comes with insurance. So Blakey never went to the doctor. When she got sick, she had to manage it herself and hope colds didnt turn into pneumonia.
But Blakey and her German-born husband, Ecki Heins, now have health insurance under the Affordable Care Act. Blakey, who sang on the N.C. Music Love Army album that grew out of last years Moral Monday protests, has emerged as a vocal ACA proponent urging her peers to sign up. She feels sheepish relief about finally joining the ranks of the insured.
To not have insurance is so real for so many people, but its also a little embarrassing, Blakey said. People look at you like youre crazy, but its been absolutely out of reach monetarily. We live a low-income, self-employed, simple life. Im pretty healthy, but I never went to the doctor. Weve been lucky to have no serious health problems. But Ive always had that nagging worry in the back of my head. The stress of living with that has been hard.
The high cost of coverage
Intense controversy has accompanied every stage of the process with the new law, commonly known as Obamacare. After surviving legal challenges up to the U.S. Supreme Court and causing a government shutdown, it figures to be one of the most contentious issues of this falls midterm elections.
Lost in all the drama is the potential impact for artists and musicians like Blakey, many of whom havent had health insurance for decades. The Affordable Care Act was designed to help the working poor and middle class buy subsidized coverage. One of the least-studied impacts of the law is its role in providing relief to the creative class, much of it comprised of artists living on the economic margins.
Last year, the Future of Music Coalition advocay group surveyed 3,400 musicians and artists. Among its respondents, the survey found that 53 percent of musicians and 43 percent of artists overall did not have insurance, mostly because of cost.
The biggest reason for everyone, 88 percent, was that they couldnt afford it, said the coalitions Kristin Thomson. Artists tend to be self-employed freelance contractors, ineligible for employer-provided group plans, and their income tends to be pieced together from multiple sources. The ACA was set up to help people like this.
The coalition plans a follow-up survey later this year. If the law works as intended, the number of uninsured musicians and artists should drop dramatically.
But sorting out the impact might take some time. The deadline to sign up through the laws health-insurance exchanges has been extended through March, and plenty of people (musicians included) have yet to figure out what to do. The 2013 FMC survey found that more than half of its musician/artist respondents were unsure how the law would affect them.
Locally, a lot of arts people wind up calling Alex Maiolo, a Chapel Hill musician who is also a program coordinator for the coalition and works in the insurance industry. Since hes a musician who knows insurance, Maiolo is uniquely qualified to serve as spirit guide for his peers by walking them through the process.
Im not surprised to see a lot of people still have no idea what to do, Maiolo said. Musicians and artists tend to be particularly bad about that, and with the sign-up deadline extended, people will still wait until the last minute. But things are quietly starting to happen. Were really past the point where it will change dramatically, so all we can do is shut up and see what happens. For now, the good part is people who have never had health care are going for checkups and getting told, Youd be a lot healthier if you lost 20 pounds and took this cholesterol medication. That will have an impact, but we wont see it for years.
The ACAs intent is to make health insurance available to nearly everyone, with subsidies on a sliding scale for people within certain income limits. It requires people to get insurance or pay a tax penalty, and for insurance companies to accept everyone with no exclusions for pre-existing conditions. Many states, including North Carolina, have refused to participate in the federal governments Medicaid expansion (which was to have covered more low-income people) or to set up state exchanges leaving residents to go through the federal exchanges instead.
Between the HealthCare.gov websites botched rollout and President Barack Obamas infamous promise that anyone who liked their health insurance could keep it inspiring blogosphere headlines like, Obama lied, my health plan died the law is off to an unpopular start. But for some who were uninsured, or even insured under plans that werent great, the law is already providing benefits.
Jason Patterson, 53, plays drums in Nantucket (and was also in Cry of Love, a band that had some good-sized rock-radio hits in the early 90s). Previously, Patterson had what he called a poor starving musician insurance plan with high co-pays and deductibles that at least covered some preventive care. It wasnt one of the policies canceled under the new law, but his insurer sent word that his monthly premium would nearly triple in 2014, to $400 a month.
Patterson wondered how hed afford it, until he checked what was available through the federal health care exchange. Getting the website to work was a prolonged ordeal, but he was able to find a policy for about $40 a month after the tax credit. Hell save $1,200 a year for better coverage than he had before, real money for a drummer running a lawn-care business who might net $20,000 a year.
Being self-employed and a musician, the money is feast or famine, Patterson said. Some years you do well, although nobodys getting rich. Some of my musician friends who have never had health insurance can now get something where they can at least go to the doctor and get a physical. Then if they find out theyve got a brain tumor, they can sell some guitars to come up with their $5,000 deductible and be covered for the rest as opposed to looking at $250,000 worth of bills for cancer.
Trouble with signing up
Problems with the website HealthCare.gov have been a recurrent issue, so a lot of people had to sign up over the phone. One of them was Caitlin Wells, 26, an actress with the Durham theater company Little Green Pig who also teaches part-time.
Wells had been getting by with a catastrophic plan similar to Pattersons. Under the ACA, shell pay around $45 a month for much better coverage. But its not clear when her coverage will actually kick in.
Somewhere between the person on the phone with the exchange and the insurance company, something got lost, Wells said. I paid online but have yet to receive information or even a card. So if I have an emergency, Im set. But until I get my policy information, I cant get a doctors appointment or prescriptions. Once I get everything figured out, it will be a much better plan.
Also having sign-up trouble is Michelle Dorrance, one of the most acclaimed tap dancers in the world. Dorrance, who grew up in Chapel Hill before going off to New York, was doing without insurance last year when she had a potentially serious problem with a piece of glass stuck in her foot for which she put off treatment because she couldnt afford it.
I had an infection for a while, and it was pain and discomfort more than anything else, Dorrance said. It could have been worse. I ended up going to see a podiatrist Id seen in the past, but it was a lot of money out of pocket to get it dealt with. Now, signing up for insurance is something I need to take care of. Im nervous about getting really injured without insurance. My body is my livelihood.
One effect the ACA might have is to render obsolete a longtime staple of local music, the benefit show for an ailing uninsured artist facing a crisis. In 2003, Texas country-soul star Alejandro Escovedo was battling hepatitis C without insurance. A number of Triangle acts, including rock band the Backsliders and Lynn Blakey, played a local benefit for Escovedo and raised more than $13,000.
The tables turned in 2010 when Backsliders frontman Chip Robinson broke a hip in a bicycle accident and Escovedo came to Raleigh and headlined a benefit show for him. Robinson declined to specify how much was raised beyond saying that the benefit show helped immensely while he was recovering.
It paid some doctor bills, but more than that it kept me alive, said Robinson, who is now 56. Helped me eat, kept a roof over my head. Now, getting signed up is on my action list. Ive never had insurance, ever.
Someone else who doesnt have insurance is William Earl Mace, 50, a Triad-area musician. Mace has been hospitalized since suffering a heart attack and stroke on Jan. 1, and the situation is dire enough that bankruptcy might be the least of his problems.
He thought he was bulletproof, so he didnt think insurance was anything he needed, said Rhonda Pierson, Maces partner. Hes a musician, so he has no work history. Well never pay this off completely. The hardest part might be the home care afterwards.
As always happens, the local music community is rallying to help out with a series of Macestock benefit shows, including April 27 at Greensboros Blind Tiger and May 24 at Southland Ballroom in Raleigh. But given the scale of medical bills Mace faces for procedures including brain surgery, it will take a lot of benefits to put a dent in his debt.
If the ACA gets more artists and musicians on insurance rolls, and they start seeing doctors more often than during catastrophic emergencies, that might make the biggest difference of all.
The community of musicians always comes together to help people who have accidents or illnesses, Blakey said. But raising a few thousand dollars that way is just a drop in the bucket. If you wind up in the hospital from a wreck, that could be $50,000 a lifetime of debt for someone just getting by. So many musicians have had catastrophes, died in debt. Maybe that time is over and we can start trying to take care of ourselves in something other than patterns of chaotic crisis.
Menconi: 919-829-4759 or www.newsobserver.com/OnTheBeat