How Will Obamacare Affect Musicians?

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Just two days after she received her brand-new Blue Cross Blue Shield of Texas insurance card guaranteeing her coverage, Alexis Kidd was in the Intensive Care Unit at Memorial Hermann Northwest. Sitting with her at every possible moment was her husband, Christian, a.k.a. Christian Arnheiter, a.k.a. Christian Oppression, but mostly just a.k.a. Christian of The Hates. This was merely the latest in a series of medical emergencies that had plagued the couple over the past five years, but thanks to the Affordable Care Act's implementation at the beginning of 2014, it was the first in a long time that could be tackled with full protection.

"If I'd had those heart palpitations without my insurance card, I would not have gone to the hospital, and the result would have probably been much worse," says Alexis, whose history with cancer had prevented her from easily finding coverage. But the ACA changed that. Her short stay in the hospital while doctors adjusted her blood-pressure medication was covered, an unheard-of luxury for her just a month earlier.

Christian himself has enjoyed full medical coverage his entire adult working life. For more than two decades, his assortment of garishly colored Mohawks accessorized his City of Houston worker's uniform, a clash of respectability and punk-rock defiance that landed his picture in a Houston Post story when questions arose about the appropriateness of such a hairstyle for a representative of the city. The matter was tabled, and Christian would reap the benefits as a city employee for his work during the day and as a punk-rock icon on the stages and radio waves of the same city at night.

But the people whom Christian has cared about and ultimately supported have not been so lucky.

Musicians and their families often fall through the coverage gap. They're typically young and consequently believe themselves invincible, and are expected to make significant sacrifices for their art. If you want to be a rock star, you'd better be ready to bleed for it. What other occupation has web sites like BetterThanTheVan.com, where groups can beg for lodging from obliging fans, or expects to meet its serious medical-care expenses through benefit-concert proceeds, in contrast to the conventional options offered to teachers and plumbers?

A typical Houston musician may receive health insurance through his or her day job (if there is one) or an insured spouse's provider. Those under age 27 may continue on their parents' insurance, assuming their parents have coverage and are willing. The National Academy of Recording Arts and Sciences' outreach program, MusiCares, aims to help artists with financial needs brought on by medical and mental-health concerns, but it's hardly a widely available safety net. If you're fortunate enough to live and work in Austin, the Health Alliance for Austin Musicians is open to the more than 9,000 musicians residing in the capital, but not the thousands more beyond Austin's city limits.

In the Houston area alone, Lee Alexander curtailed a promising singer-songwriter career so he could retain the health-care benefits that come with his teaching job. Jazz vocalist and bandleader Tianna Hall says she's scared about being able to afford the expensive therapy for her young autistic son unless certain state laws change, while many musicians in her band are effectively left to fend for themselves. And it took an elaborate benefit concert to foot the five-figure bill when veteran alternative-rocker Sean Ozz's young son broke his arm.

As the initial debate over the Affordable Care Act began in 2011, the Kidds watched the rhetoric avidly. Even after the law's passage, it would be years before Alexis would be able to take advantage of the clause that prevented insurance companies from denying applicants based on pre-existing conditions like hers.

In the meantime, Christian and Alexis got married through an organization called Wish Upon a Wedding, which provides small weddings to people facing life-threatening illness; accepted a generous handout from Dream Rooms Furniture after they were featured in a Facebook "likes" campaign that netted them the cost of a procedure; and otherwise existed in a fearful holding pattern.

"Every doctor we talked to about Alexis's history during our hospital stay asked us when we were going back to the oncologist," says Christian. "It was nice to be able to tell them it was the next thing on the list after we got out of the hospital.

"After Alexis was diagnosed with mesothelioma, she lost her job and health," he continues. "I tried applying for her to be on my health care, and she was denied because of her pre-existing condition. I was so glad when the Affordable Care Act was introduced so that people no longer had to be denied coverage."

Though the Affordable Care Act is the law of the land, in Texas its implementation — and by definition its positive impact — has been more limited than in many other states because Texas turned down Medicaid expansion. This put many low-income people in the position of making too much money to qualify for a federal subsidy while still being well above Texas's Medicaid limit.

The ACA-offered expansion of Medicaid would have provided coverage to anyone making up to 133 percent of the federal poverty level, or around $15,000 for a single person or $30,000 for a family of four. The federal government pays this expansion in full starting this year, but by 2017 each participating state will pick up 10 percent of the tab.

However, the U.S. Supreme Court has ruled that the government could offer this deal to the states but not force them to accept it. Texas opted not to accept the expansion, along with states like Florida and Louisiana. On a recent trip to Houston, U.S. Health and Human Services Secretary Kathleen Sebelius said Texas's decision costs the state $18 million in federal funding per day.

That leaves residents stuck with the old Medicaid rules, and in Texas, only the parents of dependent children are eligible. (Nondisabled people without children, such as the Kidds, are not eligible for Medicaid at any income level.) Any Texan making less than $15,280 — not unheard of for many local musicians — fails to qualify for federal aid in purchasing insurance. Luckily, though, he or she is at least not subject to fines from the health law's individual mandate at that level.

The state's rejection of the Medicaid expansion is one of the reasons Texas continues to have the highest number of uninsured people in the nation at currently around 5 million people, or one-fifth of the state's population. Put another way, only 8 percent of Americans are Texans, but 12 percent of all uninsured Americans live in Texas.

The Kidds' first brush with the health-care system came when Christian's mother suffered a stroke in 2003 that left her wheelchair-bound, partially paralyzed and ultimately unable to work. Christian devoted himself to her care, but the costs were very high. Even though she had Medicare, ultimately he was forced to sell her furniture and watch her car get repossessed in order to afford hospice care for her. The Hates played few gigs during those years, though they did have at least one memorable show during which a vanguard of punk fans ushered Christian's mother to the front of the stage in her wheelchair.

He would relive the experience of caring for a chronically ill loved one in 2007. Shortly after Christian was hit by a distracted driver while on his scooter, Alexis suddenly developed an unbearable pain in her abdomen and was diagnosed with a rare form of mesothelioma that attacked her diaphragm instead of the lungs. That day was also Christian's 52nd birthday.

At that time Alexis held not one but two jobs and lost no time in using her health benefits to the maximum. She underwent surgery and chemotherapy and even took part in a new health-advocate nurse program that basically gave her a personal assistant, ensuring that at least one person was always in her corner cutting through the red tape of the medical ­industry.

Naturally, long-term care and the effects of the treatment took a significant toll on Alexis's health and required time away from work. "After each infusion of chemo, I would be in the hospital for a minimum of three days," she says.

Eventually her day job was eliminated, leaving her without health insurance at one of the most vulnerable times in her life; her second job offered no benefits. She remained on COBRA, the federal government's program that allows for temporary continuation of health coverage, but the expense soon proved unsustainable.

The Kidds' coverage under Obamacare comes at a steep cost as well. Christian works five full days a week at Fuller's Guitar and another two full days at a multiservice center in order to pay the almost $500-a-month platinum-plan premium. It's the only one available on HealthCare.gov that allows Alexis to keep the doctors who initially saved her life in 2009. The stress of working so much takes its toll on Houston's punk elder statesman. For him, the affordable part of the Affordable Care Act is still a work in progress, though he gladly sacrifices his time and energy in order to provide the care. But at least she's covered now.

One musician who's not is Johnny Simmons, a full-time drummer who spends an average of 40-50 hours a week playing, practicing and teaching. Simmons's average pay has not increased throughout his 25-year career, he claims, but he's hopeful his extensive experience as a worship musician might help him acquire coverage through faith-based alternatives like Samaritan Ministries.

When it comes to your average bar gig, though, Simmons says he's been onstage with the likes of Toy Subs since 1986 and his payout hasn't changed significantly, either. Back then a night's pay would average $100 to $200; that's usually what he gets now. Super Happy Fun Land owner Brian Arthur provides similar numbers, saying that a local act that brings in 100 people can expect to split $350 among band members. Touring bands often receive less at the venue, though Arthur says he always makes sure to front them enough for gas and food to their next destination.

"This is why they say don't quit your day job," he cautions. "The vast majority of musicians don't even cover their expenses, much less average a positive income."

Another club owner, Rusty Andrews of ­McGonigel's Mucky Duck, confirms the haphazard, often negative cash flow experienced by some Houston musicians.

"A local musician may have a nice night and earn $1,500 or more from the door; however, he has to pay his three sidemen," he says. "Do they share equally? Who knows? Also, they may not have another gig for a week, or the next gig may bring in less than the last one. Some musicians have to have a day job to supplement their living from music, which of course raises their annual wage, and they then may not qualify for the subsidy offered by the ACA."

Andrews adds that Mucky Duck does provide its employees with health insurance, aided by the SHOP marketplace created by the ACA, and also helps bands navigate the law if needed. Recently, a sound man at the club received coverage under the law and was admitted to urgent care a week after suffering a bad spider bite.

In Texas, the cost of care versus the amount workers are paid is cause for some concern. The average amount spent on medical care per person in the United States was $1,110 in 1980, when the median income of Texans was $9,439. Twenty years later, the cost of care had risen to $8,402 per person, but Texas's median wage only went up to $39,493. The cost per person rose by 756 percent as income went up only 418 percent, a ratio approaching 2:1.

Lee Alexander moved back to Houston to begin forging a career as a singer-songwriter. In 2009, his album Mayhaw Vaudeville was being touted nationally as an underground hit, and he had regular gigs in venues across the city. Record labels were calling him with deals, everything most musicians need to believe a bright future might be in store.

Still looming, though, was the problem of what to do in the event of a medical crisis. Alexander's grandmother had contracted amyo­trophic lateral sclerosis (Lou Gehrig's Disease), the same disease that has left physicist Stephen Hawking physically disabled, and the possibility of developing such a debilitating condition frightened him. He was forced to choose between public-school teaching or taking the risks associated with pursuing his ambitions. Even though Alexander, whose wife's insurance currently covers him and their daughters, plans on releasing a Frank Zappa-­inspired children's record this year, he doesn't expect to go on tour to promote it.

"My aspirations of ever doing music full-time have disappeared," he says. "I'm in a very different station in life. It would have to take a major musical opportunity or offer to prompt me to quit and be a full-time musician. And free health care certainly wouldn't sway me.

"However, that being said, had the ACA been around back when I was in my 20s [and] an unencumbered artist, yes, I would have formed a band and hit the road," he adds. "No question."

That opportunity may have passed Alexander by, but it's not stopping Blaggards. The local Irish-rock band is a full-time endeavor that regularly tours both the United States and overseas. Bassist/singer Chad Smalley reckons that he works 50-plus hours per week, factoring in travel, rehearsal, gigging and the like. But the band is successful enough that Smalley doesn't require a day job.

Prior to his existing health plan, which he got through the ACA via HealthCare.gov, Smalley was signed up with PCIP (Preexisting Condition Insurance Plan), an early implementation of the ACA that allowed people like him to get decent coverage while waiting for the marketplace to open. Once the famously glitchy site was working, Smalley says, he had an easy time when he accessed it in mid-December 2013. He was able to get in and out easily and was amazed at what he could afford.

"Compared to the PCIP coverage I had before, my monthly premiums were cut by 60 percent, my deductible went from $2,000 to zero and my annual out-of-pocket max went from $6,000 to $500," Smalley says. "My premiums could have been even cheaper if I'd opted for a state-only plan. But since I travel a lot, I opted for national coverage.

"I even got a cheap dental plan on the marketplace...I wasn't expecting that, so that was a nice bonus," he adds. "Having guaranteed care ensures that my career won't get stopped dead in its tracks simply because I get sick or have an accident. That happens to so many people. It's sad and unnecessary."

Smalley would be bankrupt without the Affordable Care Act, he says.

Tianna Hall is an employer of sorts, depending on how you define the term. The jazz vocalist works full-time on her craft and fronts a group of 32 musicians at her performances. Her most recent release, a Christmas album with Chris Cortez, is among the best holiday offerings ever to come out of Houston. Like Chad Smalley, she doesn't need a day job to keep her going while her career takes off.

Hall is insured through her husband's employer, so she didn't need the ACA's help. But that's not to say her life is easy when it comes to medical expenses. The couple recently welcomed their second child, a joyous occasion that, even with full coverage, cost them around $8,000.

Looking at the jazz world around her, she is under no illusions that her own established music career would be profitable or secure enough to allow for insurance coverage. Hall says she sees the examples of musicians like Marsha Frazier, a former pianist for the Duke Ellington Orchestra who battled both chronic pain and poorly managed government programs, and "I'm sick to my stomach.

"These artists and creators of music that have given a soul to this country, state and city are left to be treated as second- or third-class citizens," Hall continues. "It's unacceptable. Not to mention our pay scale has been the same since before I was born in 1980, despite the rest of the country's income inflating right along with the current economy. Musicians were barely able to pay for health care then. How in the world can they possibly pay for it now?"

Hall has another problem that the ACA may yet help her with. By her own admission, mental-health problems are endemic among the musicians she comes into contact with. Depression, anxiety and substance abuse are legion. Though she herself has not experienced such problems, she has seen them among members of her group and hopes that ObamaCare will enable them to be both physically and mentally healthier.

The ACA's wording does make some improvements to coverage of mental-health problems; such conditions are listed among the ten essential benefits that plans on the health-care exchange must provide. The act requires that mental-health issues be treated the same as physical ailments and forbids insurance companies to charge higher deductibles or require higher copays. Arbitrary limits on the number of doctors' visits for mental health are likewise proscribed, with providers otherwise ordered not to treat these concerns as a lesser form of care.

"If health care was guaranteed," ventures Hall, "my music career would be astonishingly better because the 32 musicians I employ would be healthier and have access to mental-health care as well."

Despite these changes, Hall is still battling a form of mental-health discrimination thanks to her three-year-old autistic son. The state of Texas mandates that treatment for autism-spectrum disorders be fully covered by insurance until the age of nine. However, Hall's provider gets around the mandate with a "self-funded" policy, meaning that her husband's employer covers the premium and Aetna is listed as merely an administrator.

In the long run, though, the therapy Hall's son requires threatens to bankrupt her unless further changes to the law ensure coverage for the treatment. It comes at an annual cost of more than $63,000, a price tag met only through generous aid from Hall's and her husband's parents. Even that does little to ease her anxiety, she admits.

"We're scared to death," she says. "If we can't handle it financially, how in the world would John Q. Musician with a newly diagnosed autistic toddler?"

In times of trouble, many musicians end up turning to the age-old practice of the benefit concert. One good night featuring the donated talents of Houston's finest performers banding together has helped keep many of them afloat in the wake of medical catastrophes — provided they're popular enough to pull it off, of course.

Sean Ozz of The Abyss is a somewhat unlikely figure who has managed to carve a unique niche in the Houston scene. His ever-rotating band of musicians plays '90s-style goth-rock reminiscent of Bloodflowers-era Cure and has somewhat bafflingly managed a Houston Press Music Award nomination three years in a row. It doesn't hurt that Ozz's impressively spooky baritone voice makes his work extra compelling.

In 2011, he was forced to go the benefit route when his son Zain broke his arm in a rather spectacular manner, twisting the bone into a Z shape. The estimated $40,000 necessary to fix Zain's arm seemed insurmountable given Ozz's day job — he's a tattoo artist in a slow shop — and his modest income from music. But benefit shows must also account for wages lost when performers take time off to heal or care for a sick family member, not just the cost of the treatment itself. And musicians who don't perform don't get paid. The profession affords no vacation days, at least not on this level; that goes double when your day job is tattoo artist.

Ozz has been sick enough to go to the doctor only once in the past 22 years, but even if health insurance were completely free, the idea of a handout still irks him. Nonetheless, he swallowed his pride and threw himself into creating original paintings to auction off at Zain's benefit, held at BFE Rock Club in far north Houston. Bands like Provision donated not only their time but merchandise sales as well, and the money was raised. Now Ozz's son enjoys coverage through the Children's Health Insurance Program, while his father grudgingly maneuvers through HealthCare.gov to comply with the law.

But so far, Ozz says, he's unimpressed with the site's offerings; $160 a month might as well be $1,600 as far as affordability is concerned. Much of his resentment is directed toward the rejected Medicaid expansion, which he would have qualified for.

"I like the idea that everyone should be able to afford emergency health care, but I do not think ACA is the right answer to that," he says, calling it more of a workaround than a means of addressing the actual problem. "It might be a step in a direction. I guess time will tell if it is the right direction."

One musician who came to Ozz's aid for Zain's benefit concert was Christian Kidd of the Hates. Like Ozz, Christian and Alexis realize that much work must be done before reform provides decent, affordable coverage to the entire country.

"I think you've got to start somewhere," says Christian. "I think there's people that really don't like the change and think that they can still turn this back and get rid of it."

Christian rarely talks about his experiences with Alexis now that he once again has the coverage that allows his wife to monitor her disease. Much of Houston's punk and metal scene is staunchly libertarian and conservative, right down to the Hates' bass player. But regardless of politics, these musicians understand the godsend that the ACA has been to the Kidds, even if they oppose the idea on a national scale. "It does make them see the human element and not the fearmongering," Alexis says.

Meanwhile, Christian is candid about downshifting his career with the Hates while seeing to his wife's health-care needs.

"I definitely had to slow down," he admits. "I put things on hold. I grew up in a pretty conservative household. I always felt guilty because I didn't go to college and get a straitlaced job that would have allowed me to take better care of myself and others."

What he says next speaks to the couple's recent struggles as much as to Christian's punk-rock aspirations.

"I was always pretty determined to do [music] instead, but I've always felt the sacrifices for it," he admits. "You've got to do what you want to do, but it makes you aware of how things would be different if you'd become a doctor or something."

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