As Nevada Hill paints a large mural on the eastern wall of Rubber Gloves Rehearsal Studios, a giant heart in the middle whose many arteries extend all around it and each connect to its own building, he is coated in sunscreen and flecks of paint, and he is wearing a sort of tan sun hat with a brim that protects his head for 360 degrees. Under that hat is a rag that covers the back of his neck. If he has to be in the sun these days, this sort of protection is absolutely essential.
A couple of weeks ago, Hill, a DFW musician and artist, was diagnosed with melanoma, and he currently has no health insurance. His job doesn't offer it as part of its employment package, and out of his monthly pay there is no way he could afford to buy a private plan, even if he bought one with an outrageous deductible.
These were his two reasons before he was diagnosed with cancer. Now, just about any insurance company in the country will deny him coverage because he has a preexisting condition.
On August 18, he posted on Facebook, asking if anyone knew of any resources that could help him (and if you do, please post them in the comments or email firstname.lastname@example.org). The post reads:
On Friday I was diagnosed with skin cancer (melanoma). I have to have all the lymph nodes taken out of both arms and have to go through some kind of chemo. I have a large tumor under my left arm the size of a golf ball...The only reason why I'm posting this is to see if somebody knows of any cancer foundations that give money out to cancer patients with out health care. I have already looked at Livestrong, Easel and MASH. I will also be working on a mural at rgrs tomorrow so come by say hi if you're around.
Unfortunately, Hill's is not a unique problem. Twenty-five percent of Texans don't have health insurance, and nearly all full-time artists don't.
Roughly three and a half hours south of DFW in Austin, there is an alliance called HAAM (Health Alliance for Austin Musicians). HAAM has been active in Austin for the last eight and a half years.
Essentially, it is a sort of middleman between its clients, the low-income, uninsured working musicians (they must be Austin residents), and the clinics of Austin. In the past eight and a half years, HAAM has helped more than 3,000 Austin musicians get access to affordable health care, and is currently helping another 2,000.
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For myriad reasons, HAAM is and will continue to be a necessary entity in Austin and Travis County. One of the biggest is Texas' recent rejection of a Medicaid expansion offered by the Patient Protection and Affordable Care Act (most commonly known by its right-wing anointed moniker, Obamacare), and the fact that when implemented next year, the PPACA will cover people in a limited capacity and only provide subsidies to people within a certain income range.
When it comes to a sense of civic responsibility to artists and musicians, Austin is home to one of only two or three similar organizations in the country. Another example is the New Orleans Musicians' Clinic, which, like HAAM, relies on donations and grants.
Ultimately the issue of musicians without health insurance is so much bigger than most people realize. In his excellent eye-opening article for Stereogum, Max Blau lists a sizable sample of moderately famous independent musicians who have had horrid financial troubles due to not having health insurance, from Marnie Stern to Lou Barlow.
These musicians have often gone tens of thousands of dollars, sometimes even six figures in the red, because without health insurance they couldn't afford to worry about preventive care, so they didn't seek treatment until the eleventh hour, when treatment costs amount to many times more than preventive care.
Carolyn Schwarz is the executive director of HAAM, and she sees the musicians in Austin as a valuable commodity that must be protected and cared for. "We have industries here. We have big companies that recruit employees," she explains. "When they're here, the potential employees from out of town, they [recruiters] take them to go see live music, and they show them a good time. Here in Austin, you can't even barely go to the grocery store without seeing live music. So they're selling our city on that, and we also just have a huge music fan community that supports our work and believes in our work. I think that when people move to Austin, there are many reasons why they do that, but music is usually pretty high up in those reasons."
The organization's mission statement is succinct: "The mission of Health Alliance for Austin Musicians is to provide access to affordable health care for Austin's low income, uninsured working musicians, with a focus on prevention and wellness."
HAAM's own literature estimates that Austin's music industry accounts for almost $2 billion in economic activity, $38 million in local tax revenue annually, provides 18,148 jobs and boasts more than 9,000 musicians, most of whom are low income. The Austin music industry also helps to bring in tens of thousands of visitors annually through music and arts festivals, most notably Austin City Limits and South by Southwest.
Schwarz says that because Austin is the live music capital of the world, it only makes sense that the musicians who combine to give the town its global reputation should be protected. She estimates that the median income of most working Austin musicians is around $16,000. That's roughly what Hill makes, and it's not really enough for anyone to pay all of their bills and then add health insurance to that.
Two years ago in April, Hill went to a doctor to see about a problem he was having with his ear. He didn't have insurance, so his father paid for the visit. During the appointment, the doctor noticed a mole on his back that looked troublesome. Hill was instructed to take a picture of the mole and then return to the doctor in two months to see if there were any changes in the mole's shape and color. When he returned to the doctor in June, the comparison from the mole then and the mole two months prior showed no significant changes, and Hill went on with his life working as a sculpting assistant and making music and occasionally touring with the DFW band Bludded Head, among other artistic endeavors.
Two years later, in June 2013, he was on a vacation with his family in Galveston. One day at the beach, a few members of his family told him that he had a nasty looking mole on his back. It was the same mole that was inspected during his doctor's visit two years ago.
This time when he looked at it in the mirror, Hill noticed that it had turned jet black and was larger and more chaotic in shape. His father implored Hill to go to a dermatologist -- he had already suffered through two bouts of melanoma, and he wasn't about to gamble with his son's health.
Hill immediately made an appointment, and the dermatologist cut the mole out the same day and then performed a biopsy on July 27.
Right before his appointment, he remembered that one day in June he was watching television when he randomly felt under his armpit and noticed a lump. "I connected the mole and the lump together," Hill says. "And then I went to go see a dermatologist and I showed him the lump. He said that it was probably just an irritated lymph node because I work with my hands. I work in a sculpture studio." The doctor said that there was no way it could have been cancer because the lump was too big.
But when Hill went to an actual oncologist at Baylor Hospital in Dallas, the doctor said that it was definitely melanoma. He performed a biopsy just to make sure, and then went through a PET and an MRI scan to make sure that the cancer hadn't spread anywhere else. This was Friday, August 16.
"He gave me all of the results at once," Hill says. "He said, 'You have melanoma not only in your left armpit, but in your right armpit, and we have to take all of your lymph nodes out.' And I had something else on my back that they have to deal with. And people go through this all the time, but it's not something you think about. A flu you can expect. A cold you can expect. But getting cancer at 31... I mean, you always think about elderly people getting cancer, but ..." He says and then gets quiet for a moment.
His cancer isn't fatal and is treatable. But already he's accumulated an estimated $10,000 in medical bills, with the majority of his procedures still needed.
He still needs surgeries to remove a golf-ball sized tumor from his left armpit, both lymph nodes in his armpits need to be removed, and he will need some form of chemotherapy.
It's especially difficult to estimate the number of uninsured musicians in a given locale because there really are no statistics on this. You can find average salaries for professional musicians, the ones employed by studios or classical circuits for example, but in major cities and metropolitan areas such as Austin and DFW, the number of musicians making records and touring independently or on small labels far surpasses those of the professional ilk.
It's almost impossible to find numbers on independent musicians and their salaries because for so many of them just like Hill, they must work a separate job in the vicinity of waiting tables. In other words, the statistics for this demographic are typically recorded through their supplemental work, not their musical pursuits.
Also, their supplemental work typically includes jobs that will likely not provide health insurance, barely pay the bills and leave little wiggle room for a costly private health insurance payment.
According to the Rand Corp., a political think tank that counts the U.S. government as one of its clients, states like Texas that reject the Medicaid expansion are looking at around $8.4 billion in losses of federal transfer payments in the long term, as well as 3.6 million fewer people nationally being insured. The high estimation of financial loss is also largely due to the high cost of emergency care over preventive care, the former accounting for the vast majority of care that the uninsured seek out.
The report's findings conclude: "In terms of coverage, cost, and federal payments, states would do best to expand Medicaid."
Because Texas opted out of the Medicaid expansion, Schwarz says that HAAM will continue to be a necessary resource for musicians in her area for the foreseeable future. "About the health insurance market places that are unrolling on October first," she explains, "those are going to be available with a subsidy for people who earn between 100 and 400 percent of poverty [the poverty level]. The majority of our clients fall under that. The state of Texas chose not to take a Medicaid expansion, so the majority of our clients will still be left with no access to health insurance."
Schwarz goes on to explain that for the percentage of HAAM's clientele that fall between the 100 and 400 percent poverty line, their counselors will still be available to point those musicians in the right direction. But even if the PPACA mandated that everyone be required to have health insurance under penalty of law, HAAM would still be needed. "We have six services that we provide," Schwarz says. "The new health insurance market places only cover two of the six. So the mandated benefit package under the new market place plans only include medical and mental health, but they don't include things like dental, vision, hearing, nutrition. So if they get on that health insurance market place, then they'll have their medical and mental health covered by that insurance plan, but they're still going to need HAAM's help for those other things."
If Hill lived in Austin, he would qualify for HAAM. Even though his cancer is treatable, Hill still needs many procedures done as soon as possible. Back in June, right before his appointment with the dermatologist, he applied for health insurance with Humana just in case he required extended care. The move initially proved fruitful, and Humana scheduled his coverage to begin on August 1 of this year.
After he found out about his cancer and all of the procedures he needed as well as how time sensitive the treatment of his overall condition was, Hill, along with his father, asked Humana if his coverage could kick in a few days earlier. They were told no, and once the two informed Humana of the urgency of the situation, his coverage was dropped altogether because it was established that he had a preexisting condition. Health insurance companies are still not prevented from denying or terminating coverage due to the discovery of a preexisting condition. This will no longer be legal under the terms of the Patient Protection and Affordable Care Act. The stipulations of this bill begin on January 1, 2014, and prior to that, insurance exchanges will become operational on October 1 of this year.
These exchanges will allow people without insurance to shop for more affordable health care in a sort of health-insurance marketplace. As soon as this goes into effect, Hill says that he'll be the first one in line to buy insurance, but for now, his medical needs are on a shorter timeline than the timeline established by when any insurance coverage might kick in.
That leaves Hill with few options. He has very recently talked to a group that he was hooked up with through Livestrong, Patient Advocacy Group of Texas. Because he makes around $1,400 a month, he is not eligible for their services. He needed to have made $300 less per month to qualify.
"Livestrong is kind of like a switchboard to turn you on to counseling and medical help and financial help," Hill explained. "They do peer to peer stuff and all kinds of different things for you. It's a good program, it's just that one financial thing didn't work out for me. And it's frustrating because I can barely pay my bills. You know, I don't want my parents to pay for all of this stuff. I want to pay for it. But because I don't get health insurance with my job and I can't afford it myself, it then dumps on them."
Despite his search for an affordable way of dealing with his medical predicament, Hill still feels luckier than most people without insurance.
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"I'm very fortunate," he says. "My dad has taken it upon himself to take care of all of the negotiating. I have a little team of people. My girlfriend Jamie, and my dad having gone with me on each [doctor's] visit. And Jamie's been very kind and helped me schedule appointments, and just trying to keep me focused on what I need to stay focused on."
Hill acknowledges that he probably shouldn't have waited so long to look into the issue of his own health insurance, but the problem is that even if he was proactive about it, he couldn't afford it on his sculptor's assistant budget. He sometimes makes money off of his art and his music, but it's not anything substantial. He shudders to think of the position that he would be in if he didn't have his support system.
"Another thing is that I'm not even sick," he says of his current day-to-day ability to function. "I can still do all of this stuff. People that are really sick and alone, I don't even know how ... it's stupid to expect them to do all of this stuff."