Health Insurance Survey: The Results

Health Insurance and Musicians: A Preliminary Report

August 27, 2002

Contents:

Introduction: The Health Care Crisis in America
Health Insurance and Musicians
The FMC Health Insurance Initiative
Survey Goals, Methodology, Risks and Limitations
Survey Results

download report as PDF

Acknowledgements

The Future of Music Coalition would like to thank all the musicians who participated in our online survey, and our friends, colleagues and volunteers who spread the word about its existence. In particular, the FMC would like to thank the Recording Artists’ Coalition (RAC) for their financial support on this project. It is only because of their generous contribution to the FMC that we were able to complete the first phase of this effort.

The Health Care Crisis in America

One of the biggest public issues in the 21st century is the state of health care in America. From the escalating cost of health care, to prescription drug coverage, to the mounting crisis of medical malpractice insurance, it’s clear that the health care system in America is facing unprecedented challenges.

Unfortunately, the answers to these challenges are neither simple nor clear. In the mid-1990s, the Clinton administration proposed a universal health care plan that would guarantee coverage for all citizens. This overly ambitious plan became a victim of political infighting and the effort withered. However, the problems of the uninsured did not. In fact these problems have increased.

Recently policymakers have focused on health care issues again, this time attempting a piecemeal reform such as taking on prescription plans for the elderly and installing state-funded plans to cover children. While these efforts are important, they fail to address the fundamental issue; that millions of Americans face the reality of life without any coverage at all. The Uninsured in America

According to the 2000 US Census, 39 million Americans -- or approximately 14 percent of the population -- lack basic health coverage (1) . Most likely to be uninsured are people who:

• earn low incomes
• have less education
• are Hispanic
  
• are 18 to 24 years old (2)

There is a prevailing myth that the bulk of the population that is uninsured is also unemployed. This is untrue; the vast majority of Americans who lack health coverage of any kind are employed but either their employer does not offer coverage, or the employee cannot afford to purchase insurance through their jobs or on their own.(3)

The Consequences of Being Uninsured

There are substantial consequences when a significant portion of the population is uninsured, not only for individuals, but also their families, communities, and society as a whole.

Individuals who lack health insurance will very often delay or forego health care until situations get desperate. At moments of crisis they are then forced to use hospitals, emergency rooms and trauma centers to seek treatment instead of addressing health problems at a point when less expensive interventions were possible. As a result, patients can very easily run up huge medical bills that can strap an individual or family with thousands of dollars of debt.

Aside from these personal consequences there is also a significant cost for the American economy and society at large. The amount of uncompensated care delivered by hospitals in the United States grew from $6.1 billion in 1983 to $20.7 billion in 1999.(4) This cost is shouldered by taxpayers, passed on to patients, and carried by hospital systems that are already struggling with mounting operating costs, skyrocketing malpractice coverage, and perpetual nursing shortages.

Health Insurance and Musicians

It is clear that health insurance coverage is an issue that concerns a broad spectrum of citizens. The Future of Music Coalition has chosen to participate in the ongoing debate based on its particular interest in how health insurance issues are impacting its constituents; working musicians and artists.

Anecdotal evidence suggests that working musicians have had difficulty both accessing affordable healthcare and obtaining reasonably priced health insurance. Musicians and artists often work on a freelance basis – performing or composing for specific events, albums or projects – with compensation based on a contracted arrangement.

This creates two hurdles to obtaining health insurance. First, since they are usually not employees of any particular institution or corporation, they must seek out costly individual health insurance policies on their own. Second, because their incomes often fluctuate month-to-month, they may have a difficult time keeping up with premiums.

This usually leads to one of two options. Some musicians work extra jobs just to afford or obtain coverage, requiring them to juggle a music career with a full-time job to maintain benefits. Others give up, brushing off this necessity as a “luxury” that only employees of large corporations can acquire. Considering the fact that many musicians work three jobs to meet their household expenses it is not hard to understand why many musicians have come to view health insurance as an unnecessary extravagance that is out of their reach.

This situation is compounded by the reality that health insurance companies often consider musicians and artists an “at-risk” population. Whether this assessment is based on legitimate occupational health risks – frequent road travel, hearing damage, repetitive stress disorders – or by biases created by the hypothesized decadence of art culture, this prejudice certainly makes musicians and artists more difficult to insure as a group. Not only does this make access to healthcare more imperative, but also complicates artists’ attempt to obtain coverage on their own.

What Options Do Musicians Have?

The majority of working musicians have a limited set of choices when obtaining health insurance coverage. Some labor unions and organizations – in particular AFTRA, AFM, NARAS, BMI and ASCAP – have recognized this problem and made health insurance plans available to their members. While these plans are a step in the right direction, we have found that many musicians (a) do not know about their existence or (b) cannot meet the annual income some policies require to qualify for the coverage. Our research has also shown that, in many cases, the coverage offered is no less expensive than general HMO plans offered to individuals through a traditional national insurance network.

As the cost of both health care and insurance coverage continues to increase, this problem needs to be addressed. The difficulty in accessing affordable health care excessively burdens a wide range of working musicians and artists who are involved in creating the diverse cultural contributions that are fundamental to a thriving democratic society. The FMC recognizes the need to measure the extent of the problem and analyze the existing health plans in order to devise effective and comprehensive solutions for musicians.

The Health Insurance Initiative for Musicians

In November 2001, the Future of Music Coalition launched its health insurance research initiative; a three-part research project exploring musicians’ access to affordable health care and health insurance in America.

The remainder of this document is dedicated to the first component of our study, the results of our online survey. From March – July 2002, musicians visited the FMC website and answered various questions about their knowledge of and experiences with health insurance. The survey was designed to help us to better understand the health insurance needs of musicians, which will inform our future efforts.

Research Component 1: Online Survey

The first stage of our study was an online survey posted on the Future of Music Coalition website at http://www.futureofmusic.org/research/healthsurvey.cfm. The purpose of this survey was to gauge the extent of health care coverage among musicians, and to better understand artists’ experience with the provision of health insurance.


Survey Methodology

The survey included approximately 20 questions about health insurance, both closed and open-ended. Participants anonymously gave information about what, if any, health insurance coverage they held and asked how much or little familiarity these artists had with the existing musician-focused plans, their willingness to switch to other plans, and basic demographic information. Participants were also encouraged to submit additional information and personal stories about their specific circumstances via email at the conclusion of the survey.

Data collection began independently on March 15, 2002 and ran for a four-month period until July 15, 2002. We promoted the existence of the survey to roughly a dozen groups that represent or have direct contact with tens of thousands of artists including: the musician unions, performance rights organizations, activist groups such as Just Plain Folks and the Recording Artists Coalition, artist managers, music publishers, music attorneys, promoters, record labels and booking agents. FMC volunteers also delivered flyers to their local venues and music shops, and we sent public service announcements to approximately 100 nonprofit, college, and community radio stations nationwide for broadcast. Finally, we announced the existence of the survey to our approximately 2800 newsletter subscribers and encouraged them to both complete the survey and pass the link along to other musicians.

Risks and Limitations

Online survey research is inexpensive, quick, and automates much of the data processing, however we recognize its inherent limitations. First, because the survey is online, it is limited to people with internet connections and a reasonable level of skills in website navigation. While the numbers of Americans who have internet connections continues to increase, there are still significant numbers of individuals who do not have consistent access. To counteract this limitation we made a sincere effort to publicize the existence of the survey through various measures – flyers in record stores and at shows, during public speaking engagements, through the media, and via PSAs on non-commercial radio. While it does not directly address the internet access problem, we hope that a variety of musicians found out about the survey and could seek out the survey if they wished.

Second, we recognize the problems in limiting the population of respondents to “musicians”. “Musician” is difficult to define with certainty and could encompass everything from working professionals, to songwriters, to hobbyists. We were less concerned about creating a strict definition for musician because we think it’s important to hear from all types. Instead, we included two questions in the survey that attempted to categorize their level of participation – the percentage of their time they spent being a musician, and the percentage of their income derived from being a musician. During the data analysis phase we only removed those respondents who answered 0 percent for both of these questions.

Third, we recognize the risk of self-selection bias in a survey like this. The musicians who are most likely to feel compelled to respond to a survey about health insurance are those who have either (a) had a bad experience or (b) are unsatisfied with their current situation. As a result we would expect the numbers to skew higher, with a greater number of respondents being those that do not have health insurance. To counteract this problem, we made it very clear in our promotion effort that we wanted to hear from every musician – whether they had health insurance or not.

On an contrary note, we would expect a portion of the main segment we want to hear from – working musicians – could be on the road currently with no internet access. It’s our assumption that these folks, the people on the road many months out of the year, are the least likely to be insured because they make little money and have no day job. If this assumption is true, we would expect the numbers to skew lower since the folks who do not have health insurance would not have access to the online survey while on tour. We tried to counteract this problem through our promotional efforts.

Click here to see the survey results

Notes

1. “Health Insurance Coverage 2000”, US Census Bureau
   http://www.census.gov/hhes/hlthins/hlthin00/hi00ta.html
   
   
2. “Who is Most Likely to Be Uninsured?” Robert Wood Johnson Foundation fact sheet, February 10, 2002
   http://coveringtheuninsured.org/factsheets/display.php3?FactSheetID=26
   
   
3. “Myths and Realities about the Uninsured” Robert Wood Johnson Foundation fact sheet, February 10, 2002 http://coveringtheuninsured.org/factsheets/display.php3?FactSheetID=21
   
   
4. American Hospital Association, 2002.

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