A Victory for the Creative Economy

In a surprise ruling, the Supreme Court this morning upheld nearly the entirety of the Affordable Care Act, including the controversial individual mandate provision. We can now get back to the important work of implementing the law between now and 2014. This is great news for America, but it is an especially welcome development for the nation's two million artists.

Our community offers a preview of the 21st century labor force. Untethered by traditional employment relationships, artists are mobile, independent, and compensated based on the fruits of their intellectual labors. They are also chronically underpaid and, when it comes to traditional employment benefits like health insurance, largely expected to fend for themselves.

Due to historical quirks of a dysfunctional health care system -- namely that it has relied primarily on employment-based coverage -- over 600,000 American artists are uninsured. Those who do have insurance often must purchase it on the individual market, where they have faced higher rates, medical underwriting that denies coverage because of existing conditions, and opaque bureaucracies whose sole purpose is to avoid paying claims.

At Fractured Atlas, we've been working to provide artists and creative entrepreneurs with affordable health insurance since 2001. As a nonprofit, we help our members understand their coverage options, guide them through the enrollment process, and advocate on their behalf. Yet we have always been powerless to change the fundamental structure and economics of the health care industry, and despite our best efforts, we have managed to insure less than 1% of those in our community who need it.

The Affordable Care Act is a game-changer. Let's recap:

• The foundation of the law -- guaranteed coverage for existing conditions -- is an unqualified win. I've seen a 23-year-old vegetarian dancer get turned down for coverage because of her eczema. This is not what a rational, functioning marketplace looks like.

• The new insurance exchanges are designed to serve individuals and small businesses without access to big employer group plans. By accessing a state-run exchange, artists can benefit from one-stop shopping for all available plans -- including government-run and private options--and the ability to compare plans side-by-side, including benefits, networks, and price. Consolidated offerings and standardized language empower consumers to make the best choices possible, while increased transparency and simplified shopping increase competition and drive premiums down.

• Meanwhile, the individual mandate -- which was considered a near certain casualty of this morning's ruling -- is the linchpin to the entire apparatus. Forcing the "young invincibles" to participate in the system will stabilize the risk pool and bring down rates for everyone. It will reduce unreimbursed emergency care, which increases costs throughout the system. Most importantly, without a mandate it is essentially impossible to require insurers to cover anyone without regard to pre-existing conditions; the result would be a "death spiral" of ever increasing premiums, leading ultimately to huge increases in the ranks of the uninsured.

The future survival of health reform is now relatively secure. It could still be overturned by Congress, so the next two years are politically sensitive, but it's probably safe for the arts community to enjoy a collective sigh of relief. To the extent that these workers are the vanguard of America's emerging creative economy, we should all appreciate that this means we are a bit better prepared to face our economic future.