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 Hospital in Houston. Sitting with her was her husband, Christian, a.k.a. Christian Arnheiter, a.k.a. Christian Oppression, but mostly just a.k.a. Christian of punk band The Hates. This was merely the latest in a series of medical emergencies that plagued the couple over the past five years, but thanks to the Affordable Care Act's (ACA) 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 prevented her from finding coverage easily. But the ACA changed that. Her short stay in the hospital while doctors adjusted her blood-pressure medication was covered, which wasn't the case for her just a month earlier.
Christian 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 reaped the benefits of a city employee during the day and a punk rock performer at night.
But the people about whom Christian cares have not been so lucky.
Musicians and their families often fall through the coverage gap. They're typically young, believe themselves invincible and feel they must make sacrifices for their art. If you want to be a rock star, you'd better be ready to bleed for it. What other occupation expects workers to cover medical expenses through benefit concert proceeds instead of conventional options offered to teachers and plumbers?
A typical Houston musician may receive health insurance through his or her day job or an insured spouse's provider, or those under 27 may continue on their parents' insurance. 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 not a widely available safety net. If you're fortunate enough to live and work in Austin, Texas, the Health Alliance for Austin Musicians is open to the more than 9,000 musicians living there, 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 autistic son unless certain state laws change, and many musicians in her band are effectively left to fend for themselves. It took an elaborate benefit concert to foot the five-figure bill when veteran alternative rocker Sean Ozz's son broke his arm.
As the initial debate over the ACA began, the Kidds listened avidly to the rhetoric. Even after the law was passed, it took years before Alexis was 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 married through an organization called Wish Upon a Wedding, which provides small weddings to people facing life-threatening illnesses. They also accepted a donation from Dream Rooms Furniture after they were featured in a Facebook "likes" campaign that netted them the cost of a procedure.
"Every doctor we talked to about Alexis' history during our hospital stay asked us when we were going back to the oncologist," Christian says. "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 ACA is the law of the land, its implementation — and by definition its positive impact — has been more limited in Texas 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 the Medicaid limit in Texas.
The ACA-offered expansion of Medicaid would have provided coverage to anyone making up to 133 percent of the federal poverty level — 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, along with states like Louisiana and Florida, opted not to accept the expansion. On a recent trip to Houston, now-former U.S. Health and Human Services Secretary Kathleen Sebelius said Texas' 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. He or she is not, however, 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: about 5 million, or one-fifth of the state's population.
The Kidds' first brush with the health care system came when Christian's mother suffered a stroke in 2003 that left her in a wheelchair, partially paralyzed and unable to work. Christian devoted himself to her care, but the costs were high. Even though she had Medicare, Christian had to sell her furniture and allow her car be repossessed in order to afford hospice care. The Hates played few gigs during those years, but in one show a vanguard of punk fans ushered Christian's mother to the front of the stage in her wheelchair.
He relived the experience of caring for a chronically ill loved one in 2007. Shortly after Christian was hit by a distracted driver while riding 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 her lungs. That day was also Christian's 52nd birthday.
At the time, Alexis had two jobs and used her health benefits to the maximum. She underwent surgery and chemotherapy and participated in a new health advocate nurse program that in effect gave her a personal assistant to help her cut through red tape. Long-term care and the effects of the treatment took a toll on Alexis' health and required her to take time away from work. Eventually her day job was eliminated, leaving her without health insurance at a vulnerable time; her second job offered no benefits.She remained on COBRA, the federal government's program that allows workers who leave a job to temporarily continue health coverage, but cost proved prohibitive.
The Kidds' coverage under Obamacare comes at a steep cost as well. Christian works five days a week at a guitar shop and two 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 ACA is still a work in progress, but at least Alexis is covered now.
Johnny Simmons is a full-time drummer who spends an average of 40 to 50 hours a week playing, practicing and teaching. Simmons says his average pay hasn't increased throughout his 25-year career, 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 food and gas to their next destination.
"This is why they say, 'Don't quit your day job,'" he says. "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 Supper Club, confirms the often negative cash flow experienced by some working 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 provides its employees with health insurance, aided by the Small Business Health Options Program marketplace created by the ACA, and 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 spider bite.
In Texas, the cost of care versus the amount workers are paid is cause for concern. The average amount spent on medical care per person in the U.S. 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' 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 touted nationally as an underground hit, he had regular gigs across the city and 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 ALS, the same disease that has left physicist Stephen Hawking and former New Orleans Saints player Steve Gleason physically disabled, and the possibility of developing the condition frightened Alexander. He was forced to choose between teaching in a public school or taking the risks associated with pursuing his ambitions. Alexander, whose wife's insurance currently covers him and their daughters, plans to release a Frank Zappa-inspired children's record this year, but 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. No question."
That opportunity may have passed for Alexander, but it's not stopping Blaggards. The Irish-rock band from Houston is a full-time endeavor that regularly tours both the United States and overseas. Bassist/singer Chad Smalley reckons he works 50-plus hours per week if one factors in travel, rehearsal, gigging and the like. But the band is successful enough that Smalley doesn't require a second job.
Prior to his existing health plan, which he got through the ACA via HealthCare.gov, Smalley was signed up with PCIP (Pre-existing Condition Insurance Plan), an early implementation of the ACA that allowed people like him to get decent insurance coverage while waiting for the marketplace to open. Once the government site was working, Smalley says, he accessed it in mid-December 2013 and was surprised 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," he 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. ... 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 says he would be bankrupt without the ACA.
Tianna Hall is a jazz vocalist who works full time on her craft and fronts The Houston Jazz Band, a group of 32 musicians. Her most recent release, Noel, a Christmas album with Chris Cortez, is among the best holiday offerings to come out of Houston. Like 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 doesn't mean her life is easy when it comes to medical expenses. The couple recently welcomed their second child and even with full insurance coverage, it cost them about $8,000.
Looking at the jazz world around her, Hall says she was under no illusions that her own established music career would be profitable or secure enough to allow for insurance coverage. She says watching musicians like Marsha Frazier, a former pianist for the Duke Ellington Orchestra, battle chronic pain and poorly managed government health programs, makes her "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 says. "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 says she hopes Obamacare will enable musicians to find help for health issues common in the industry, including depression, anxiety and substance abuse. The ACA makes some improvements to coverage of mental health problems — such conditions are listed among the 10 essential benefits that insurance plans must provide to comply with the ACA. The act also requires that mental health conditions be treated the same as physical ailments and forbids insurance companies from charging higher deductibles or requiring 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, 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," Hall says.
Despite the changes, Hall says she is battling a form of mental health discrimination because of her autistic son, who is 3. The state of Texas mandates insurance fully cover treatment for autism spectrum disorders until a patient is 9. Hall's provider gets around the mandate with a "self-funded" policy, meaning that her husband's employer covers the premium and Aetna insurance company is listed as an administrator.
In the long run, Hall says her son's therapy could bankrupt her unless there are further changes to the law. It comes at an annual cost of more than $63,000, a price tag met only through generous aid from Hall and her husband's parents.
"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 turn to the age-old practice of holding a benefit concert.
Sean Ozz of The Abyss has managed to carve a unique niche in the Houston scene with an ever-rotating band of musicians who play '90s-style goth-rock reminiscent of Bloodflowers-era Cure. In 2011, he was forced to go the benefit concert route when his son Zain broke his arm, twisting the bone into a Z shape. The estimated $40,000 cost to repair 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. 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 created original paintings to auction at Zain's benefit, held at BFE Rock Club in far north Houston, where bands donated their time and merchandise sales to raise money.
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. So far, Ozz says, he's unimpressed with the site's offerings and is upset about the rejected Medicaid expansion, for which he would have qualified.
"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. "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 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.
"You've got to start somewhere," Christian says. "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 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 that the ACA has been a godsend 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 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 says. "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."
— This story first ran in the Houston Press.