Dr. David Hinkamp works at the University of Illinois at Chicago, codirecting the Health in the Arts Program—a medical clinic that was founded to research and treat problems specific to artists and then started offering artists basic care, too, because so many needed it. But he's long looked with envy on a similar entity, New York's Al Hirschfeld clinic for uninsured and underinsured people in the entertainment industry, run by the Actors Fund. One big difference between Health in the Arts and Hirschfeld is that uninsured artists in Chicago are charged for care—they go through a financial evaluation and pay according to their means. The New York artists get Hirschfeld's services for free.
Last week Hinkamp sat on a panel at the city-run Storefront Theater on Randolph that also included James Brown, director of national health services for the Actors Fund. Brown, a former New Jersey health insurance regulator, was in town to explain how federal health care reform will affect artists, about a third of whom, he says, are uninsured.
"This is a big deal," Brown told the modest crowd, echoing (but strategically abridging) Joe Biden's more colloquial comment to President Obama when the Affordable Care Act was signed in March. Most of the people now served by Hirschfeld, he told me later, won't need its services anymore. And the all-too-familiar benefit event for an ailing artist who's racking up astronomical medical bills should be history, too. (There's one for Chicago fringe-theater icon Beau O'Reilly—whose insurance, he says, doesn't cover necessities like anesthesia and physical therapy associated with his recent knee replacement surgery—Sunday, November 14, 3 PM, at the School of the Art Institute.)
Brown notes that Obamacare—or "Obama cares," as he puts it—isn't what he wanted. Like "anybody who really understands health insurance," he says, he was backing a national single-payer plan. "Because the healthy pay for the sick, the more people you have in the same pool, the better it works. The insurance companies are middlemen that ought to be eliminated." Margie Schaps, executive director of the Health and Medicine Policy Research Group think tank, says about 18 percent of current medical expense is consumed by administrative costs in the private sector while administration for Medicare, "the single-payer system we already have," amounts to a maximum of only 4 percent. The Affordable Care Act lacks meaningful cost reduction and a solid explanation of how the government will pay for all it's promising, she says. "Our fear is that the implementation will not be successful and that health care costs will continue to rise at unsustainable rates," Schaps adds. "We think the only way to bend the curve on health care costs is to have a national system, an expanded Medicare program. Medicare's not perfect, but it has the highest satisfaction rates of any insurance in this country."
But barring the success of the current campaigns to challenge or repeal it, the Affordable Care Act will extend health insurance to about 30 million people who don't have it now, and, Brown says, help a lot of artists, many of whom are self-employed or work for small firms that'll be getting new tax credits for offering their employees health insurance.
Parts of the law have already taken effect. Since last July, if you've got a pre-existing condition and have been without insurance for six months or more, you can get subsidized coverage through a state high-risk pool. In Illinois, Brown says, that kind of coverage for a nonsmoker his age (61), used to cost $1,316 per month. Now the price is $526 per month. Still a lot of money, he notes, but a big improvement.
And here's some of what went live last month:
Insurance companies can no longer deny coverage to kids under 19 with preexisting conditions.
Effective immediately on new contracts and at annual renewal for existing contracts, kids can be covered by their parents' policy until their 26th birthday.
There are no more lifetime dollar limits on the amount of your benefits—again, effective immediately on new contracts and at annual renewal for existing contracts. Annual limits, however, won't be dropped until 2014, and insurers are battling to save them.
Your insurer can't retroactively cancel your policy if you get sick.
Starting in 2014, Medicaid, currently available to children, mothers of dependent children, and the disabled, will be expanded to include just about anyone whose income is 133 percent or less of the federal poverty level, which is now $10,830 for an individual.
Also in 2014, the mandate for near-universal coverage kicks in, and so do penalties for those who don't conform. But if you're under 30, you'll be able to opt for catastrophic-only insurance at a relatively low premium. No insurer will be able to refuse to cover you, and you won't have to be on someone's payroll to get insurance. Subsidies for insurance premiums will be expanded to people with incomes up to four times the federal poverty level.
Perhaps most amazing, there'll be reasonable limits on what any one person or family has to pay out for medical expenses in a single year: in today's dollars they'd be $5,950 for an individual, $11,900 for a family, not including insurance premiums.
Cosponsored by the Department of Cultural Affairs and Career Transition for Dancers, last week's panel, "Creatives at Work Forum: Health and Social Services for Performing Artists," included doctors (two dancers and a violinist) from the Rehabilitation Institute of Chicago, which offers the Medical Program for Performing Artists, in which patients are treated by a team and matched with physicians who understand their art form. The services of these "physiatrists" don't come free, but those of two other panel members do: Maryellen Langhout of Career Transition for Dancers provides counseling on nonperformance work to midwestern dancers 16 and up, and Don Towne, a clinical social worker handling the central region for the Actor's Fund, provides social services to entertainment pros, including emergency financial assistance and short-term counseling.
Hinkamp still wants to start a network of free medical providers for artists in Chicago. He says it'll be needed even after the Affordable Care Act takes hold—some of those twentysomethings who opt for catastrophic coverage, for example, will require basic preventive care. And then there are the mouths: dentistry is mostly absent from the reform act.
Hinkamp would like to recruit colleagues across the medical spectrum to "participate in a network where they would see, evaluate, and treat people at their own locations." He's already working with a dozen of them, but thinks "with a little bit of seed organization this network could be big. I think there are a lot of physicians, physical therapists, dentists, oral surgeons, who'd be willing to give some small portion of their work time to this program, but who don't want to have to get credentialed at a new place, change their malpractice insurance, fill out more forms, or go through any additional office work to do it. If it's small and doesn't interfere with a lot of other things, people will be willing."
The problem, he says, is that he doesn't have the time to do the groundwork organizing—"and getting money for it is like pulling teeth."
Meanwhile Hinkamp's UIC clinic offers both specialized and basic medical care to artists of all kinds. And the Actors Fund's Brown does phone consults on insurance with people working in the arts in any capacity—from teachers to ticket takers, he says—anywhere in the country. Actors Fund staffer Renata Marinaro has also written a neat little booklet, "Every Artist Insured: Understanding Health Care Reform," available at the Artists' Health Insurance Resource Center website, ahirc.org.