Politics & Government

Health reform auditions in Hollywood

Before her injury, dancer Chisa Yamaguchi could catapult 12 feet in the air from a towering stage structure, but Hollywood’s brass ring of health insurance was always out of reach.

Then came Obamacare.

The President’s embattled health law could play the role of a lifetime for California’s arts and entertainment community. It promises to expand health coverage beyond a relative few who work enough to qualify for Screen Actors Guild insurance, or who dig deeply into their wallets for individual plans.

But as they seek health care access – some facing profound injury or illness – performers are discovering sobering realities in health reform. They include limited provider networks and subsidy rules that are ill-fitted for the unpredictability of Hollywood incomes.

“Looking at the Bronze and the Silver and the Platinum plans, well, what network pertains to the fact that I’m a hardworking dancer-athlete? Can I put those stats in?” asked Yamaguchi, 29, who is uninsured and seeking treatment for a knee injury that could end her career.

Yamaguchi and others are finding that their annual incomes, which vary wildly from casting call to casting call, make it difficult to come up with an accurate projection to qualify for premium support.

Project too high, and subsidies decrease. Project too low, and a tax bill waits at year’s end.

It is a scenario that reaches far beyond Hollywood, impacting millions of Americans with cyclical incomes. From construction workers to truck drivers, the blue-collar heartland has something in common with the entertainment rank and file.

“Just like many in the working class, your average artist has either gone uninsured, settled in the community clinic system, or scraped by,” said Dan Kitowski, director of health services for the western region of The Actors Fund, a nationwide safety net for performing arts and entertainment professionals.

Trying to estimate income “ultimately will be worth it,” added Kitowski, whose organization received a $435,000 outreach grant from the state-run health reform exchange Covered California. “But as much as we try to explain that to them, they’re hard to convince.”

The opportunity is not lost on composer Carol Kroger, 59, who suffers from a chronic form of leukemia.

It’s “the disease you die with, not the disease you die from,” said Kroger who credits a decade of work with trusted oncologists to keep her illness at bay.

Still, pre-Obamacare, she watched her individual health insurance premium climb to more than a fourth of her income: $1,020 a month with a deductible that averages $2,500 a year.

She says her annual salary of just under $45,000 is relatively stable through real estate work and modest royalties for a ballad titled “The Commitment” that she composed in her 1970s bell-bottom days.

She qualifies for a subsidy under a Gold plan that has no deductible and would slash her premium to $490 a month.

But “can I still go to Cedars?” she asked, referring to The Cancer Institute at Cedars-Sinai Medical Center where she receives treatment, along with clinical trials at a UCLA facility.

When she scanned the Covered California and hospital websites before Thanksgiving the answer was yes, but not with the plan that is the best fit.

Cedars-Sinai accepted only one plan from Covered California, a Health Net plan in the Bronze category. With that plan, her payments would be further cut to $322 a month, but her deductible would be doubled to $5,000.

“Anything is going to be better than what I have now,” she concluded, though she still needs to confirm that her doctors at Cedars will accept the plan for their separate office fees.

Kitowski said 1 in 10 artists seeking emergency financial assistance from The Actors Fund cite health-related expenses as the reason. The organization has so far directly reached an estimated 4,700 people in its Covered California effort, while distributing materials to hundreds more.

The U.S. Bureau of Labor Statistics reported in September that 1.2 million workers nationally are in the performing, motion picture and sound-related industries, though it includes professional athletes in these categories.

About 18 of 1,000 workers in the Los Angeles metro area earn their living in entertainment, the highest concentration in the country.

“I don’t think there’s any actor out there who doesn’t watch the Academy Awards and wonder if that could someday be me,” said Hollywood veteran Bubba Dean Rambo, 59. “But for most working actors, it’s all about the insurance.”

Many find themselves in a turnstile of Screen Actors Guild health coverage, landing enough jobs in one year to qualify, and missing out on them the next. Royalties from previous roles complicate the equation.

Actor-dancer-singer Rambo has a holiday wish: surging rentals of the movie “Four Christmases,” in which he played the role “Elder Baritone Singer.”

If enough pay-per-view and rental customers cuddle up with the Vince Vaughn and Reese Witherspoon feature, he could earn the royalties required to keep his SAG plan.

If they don’t, and he is unable to land roles to take up the slack, he’ll have to pivot to Covered California or COBRA, the federal temporary extension of employer-based insurance.

Covered California spokeswoman Sarah Sol said there is a three-month grace period to report a change in insurance status. If that is not enough time, she suggested that actors in Rambo’s situation pay their exchange premiums in full without help from a subsidy. Then, at the end of the year if it turns out Rambo didn’t re-qualify for SAG coverage, he could receive a lump-sum subsidy.

Rambo is unsure if he can stretch his budget that far each month. A Gold plan that would work well for him and his wife is $672 if he were to receive a monthly subsidy.

If he were to attempt to pay the premium without a subsidy, the monthly bill nearly doubles to $1,334.

For the injured dancer Yamaguchi, the problems were more fundamental as she tried to rebound from what she believed was either a torn ligament or meniscus.

“Their bodies are their instruments,” said Joanne DiVito, Los Angeles administrator for the national nonprofit Career Transition for Dancers, which tried to help Yamaguchi.

Yamaguchi needed a specialist to examine her knee and determine if she could continue perfecting her daredevil style with the company Diavolo, where she has danced for seven years.

The Los Angeles-based international company uses everyday and abstract structures, some weighing 3,000 pounds, to explore relationships between the environment and the fragility of the human body.

But the less-aesthetic realities were that Yamaguchi earned no more than $28,000 a year, couldn’t afford an individual plan, and was unsure if Covered California could help.

“The average age of a dancer to retire is 29, and I’m 29 now,” she said.

But she was also doing the best dancing of her career. “This is my gift. I have to give it away,” she said.

Colleagues recommended she see a leading physical therapist who had treated them.

Yamaguchi told the company founder of her situation. He agreed to cover immediate visits to the therapist.

But she needed to get insurance come the new year. The only option was health reform.

For her, it worked. She found a Covered California plan for $240 a month after the subsidy. Importantly, the physical therapist had his office make sure it accepted the plan.

“It’s like a second wind,” Yamaguchi said.