Affordable Care Act and Vocal Artists: How much will it help?

Does the Affordable Care Act help Vocal Artists? Some, not enough.

Singers, actors, public speakers: as the new Affordable Care Act (ACA) morphs from political football into real changes in healthcare access and financing, how will it affect you as a vocal artist? 

 The good news: Once all the provisions kick in (2014), you'll be guaranteed some kind of health insurance, and the government will help you pay for it.

  • Most young adults (through age 26) already know that if you don't have insurance through an employer or school you can now piggyback on your parent's plan.
  • Anyone who can't find an affordable private plan will have the option of coverage through a state-level Health Benefit Exchange (HBEX). This option will especially help freelancers and those whose employers don't offer insurance (hello, actor-waiters and indie musicians!)
  • For most income groups, tax credits will reduce the cost of your insurance premiums—a benefit that now applies only to employers—and you may qualify for further help with out-of-pocket expenses, which will also be capped according to income.
  • Everyone will be protected against insurer discrimination based on health status or gender, and against being booted off a plan after you get sick. Changing jobs will no longer mean losing benefits, because you can't be denied new coverage due to a pre-existing problem.     
  • ACA will require that all health plans, including the Exchanges, provide a set of "essential health benefits" (EHB), something not guaranteed today.

The bad news: The special problems of voice care may not change much, or not right away.

  • Medical care of the artistic/professional voice remains an under-represented subspecialty within the field of otolaryngology, far from the primary care emphasized in the ACA. With improved access to health coverage, vocal artists may stay in better health generally, but access to specialty clinics will remain a problem.
  • The definition of Essential Benefits is being negotiated state by state. Despite constant political jawboning about our service-and-communication-based economy, rehabilitation services for speech (voice) and hearing are not yet secured as a core benefit, even here entertainment-heavy California. 
  • Private insurers already follow Medicare/Medicaid guidelines when determining their minimum coverage, so the definition of EHB for poor folks (like, um, artists?) will affect the care available for everyone. A minimum or HBEX plan that covers your ENT visit but not follow-up voice therapy would make as much sense as a knee exam without physical therapy, but at the moment that could happen.

What to do right now:

  • Get on your parents' plan if you can, and start looking towards the job and lifestyle changes you'll be able to make once the full ACA kicks-in in 2014.
  • Start a private savings account for the vocal health care that still won't be fully covered. Throw in $10 every week, more when you can, and in a year you'll have enough for a good throat exam.
  • Find out (now) where the best voice clinic is in your area. This type of clinic will have one or more Ear-Nose-Throat doctors (ENTs) who regularly use videostroboscopyfor vocal exams, who understand performing artists' needs, and who work with speech pathologists also specialized in voice care (aka voice therapists.) Think of this as a sports-medicine clinic for vocal athletes.
    • To find a voice clinic in North America, check the directory at this Baltimore center: My colleagues there updated it just last year.
    • If the closest voice clinic is a half-day drive away, it is still worth going the distance. Throw a little extra into your Voice Account to cover gas and a day away from your other jobs.
    • For worldwide referrals: contact The Voice Foundation index.php?option=com_content&view=article&id=130&Itemid=30.
    • If you notice voice trouble now or in the future, getting prompt, state-of-the-art diagnosis and treatment will save you time and money in the longer term. So as soon as you get the info, call to find out their cash price for a singers' checkup.
  • For those immediately thinking of Adele's or Julie Andrews's vocal surgeries and ready to run screaming from any mention of throat doctors: rest assured that for up-to-date voice ENTs, surgery is not the first choice or the pre-ordained result of getting looked at! Surgery is the last-choice for singers—extreme enough to make the celebrity news. Adele also got months of voice therapy in London, which didn't make the glossies.
  • Take preventive care seriously, and educate yourself beyond singers' folklore and google-forums. Insured or not: wellness is always less costly than problem care. My website,, gets you started and links you to other reliable info; my facts-not-fiction, holistic-care-friendly book returns in September.
  • If reading this blog has awakened some niggling fears that you're already in voice purgatory, if not hell: find your closest specialty clinic and go now, scraping/borrowing whatever it takes. We're not in the dark ages any more; high-tech, sympathetic help is available. Your fabulous, unique, loyal, but sometimes fragile vocal cords deserve no less.
  • If you're in the USA and want to get involved in the regulatory battles over the Affordable Care Act, contact your state legislator or insurance commissioner. Call to schedule a chat with a health staff person and bring your coolest promo kit and this article, plus flowers or a yummy snack to cheer their office (it's a pitch session, after all). Explain that if they love music they have to include speech and hearing services in the package of essential health benefits (EHB). Then write a song about the experience, and send it to me!

Joanna Cazden



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