Musicians, artists and small-business owners wrestle with the potential rollback of the Affordable Care Act

There certainly is never a “good” time to get cancer, but there are circumstances that can make such a diagnosis worse. For example, you could be a self-employed, full-time musician used to relying on your spouse's company-provided health insurance — and going through a divorce.

That was Clintonville-based bassist Matt Paetsch's experience approximately a decade ago when he was diagnosed with melanoma. One month before his divorce was finalized, he called health insurance companies hoping to transition to a new insurance plan without a lapse in coverage.

“I was told in the state of Ohio at that time, a divorce was considered a gap in coverage,” Paetsch said. And because he received his diagnosis prior to that one-month gap in coverage, he now had a “pre-existing condition.”

“I was just told, ‘You're uninsurable; we can't do business with you,'” Paetsch said.

That scenario may seem absurd today, several years after the enactment of the Affordable Care Act (ACA), or Obamacare, which, in part, prohibits insurers from refusing coverage or charging higher rates because of pre-existing conditions. But with President Trump and Congress taking measures that could lead to a repeal of the ACA, U.S. citizens — especially artists, musicians and small-business owners — who rely on the system are worried they'll no longer have access to affordable health insurance.

President Obama signed the ACA on March 23, 2010. With an intent to create a “level playing field,” the law allows individuals and small businesses to shop for plans on the Health Insurance Marketplace, providing income-based tax credits to assist with coverage costs. Additionally, under the ACA, the Medicaid program was expanded to provide free health care for more low-income adults. Other features include cost-free preventive services and more affordable and inclusive health care for Medicare recipients and women — including coverage for contraceptive methods.

According to a Dec. 13, 2016 report by the U.S. Department of Health and Human Services (HHS), the U.S uninsured rate dropped from 15.5 percent in 2010 to 9.4 percent in 2015. Ohio's uninsured rate dropped from 12.3 percent to 6.5 percent.

And according to a Jan. 10 report by HHS, 11.5 million individuals have signed up for coverage under Obamacare as of December.

“When the Affordable Care Act came along … there were a number of things that were really good for me,” said Paetsch, who recalled almost giving up his full-time music career prior to the law.

“There was one guy … that I talked to at one of the major insurance companies that suggested to me, ‘Well, why don't you get a job that offers group insurance? Or why don't you go get a graduate degree and get insurance through school?'” Paetsch continued. “It's really hard to be a full-time musician and then have a full-time job; that's insane. And I had no interest in racking up more debt from college.”

With assistance from the Ohio Department of Insurance (ODI), Paetsch eventually got his health insurance extended for one year through COBRA (a law passed by Congress in 1986) — but at a cost of about $700 per month, more than double his previous premium. And although Paetsch's melanoma was caught early enough to cure without chemotherapy, he wanted to be prepared in the event the cancer returned.

“I'm forced to look at it in terms of either letting the system bleed me dry slowly by having it dip into my savings every month to pay for health care, or roll the dice and if I get cancer again, I lose everything,” he said. “And when you're scared … you go, ‘Well, bleed me dry.'”

A year later, with more help from the ODI, Paetsch was told he could do business with a health insurance company, but as a “high-risk” consumer with the same costly premium and a $5,000 deductible. By comparison, with his current Obamacare plan, even with his predisposition for cancer, he pays about $330 per month with a $1,000 deductible.

Paetsch, now 38, says because he is more established in his music career, he anticipates he'll survive another high-cost plan should the ACA get repealed.

“I'm worried about the next generation,” he said. “What happens when they slip through the cracks and they get cancer and they get divorced and they get scared and they have no answers and no one wants to help them, and maybe they're not as vigilant as I am to go to the state of Ohio and say, ‘Help me.' … Those people may have to quit.'”

Such fears are already on the minds of younger Columbus artists like 24-year-old Katerina Harris, a part-time acrylic painter and part-time program associate at Transit Arts. Previously on her father's insurance plan, she signed up for Obamacare after he lost his job.

“Right now I'm just trying to immediately schedule doctors' appointments so that I can at least get some care out of the way so if [the ACA] does get completely repealed, at least … I won't be totally screwed,” she said.

“It definitely is pretty scary,” said 29-year-old painter Adam Hernandez, who took advantage of the ACA when he quit his job to focus on art full time in 2015. “If I have to go without insurance for a little while, I probably would. That would really suck because … it was nice to be able to go get check-ups and start taking preventive measures for my health.”

Both Harris and Hernandez said they acknowledge that while the ACA has been beneficial for them, there may be disadvantages for others.

“I'm sure somebody could … point out some things that I'm not realizing, so I'm willing to hear somebody out, as well. But when it's affecting me personally, I guess it's kinda hard for me to see it from the other side,” Hernandez said.

“Obamacare is increasing costs for middle-class families, with premiums up by nearly 100 percent for many families over the last six years while wages have been largely flat,” Sen. Rob Portman said in an email to Alive.

“After six years of the status quo, it is clear now that health care costs have grown out of control for many Ohioans and that the ACA has failed in its promise to prevent this cost growth,” he said. “The federal government has spent over $1 trillion to increase coverage, and yet 10 percent of the national population remains uninsured, to say nothing of the people who have had their access to their providers limited as a result of President Obama's health law.”

In a Jan. 18 letter to Congress, Ohio Gov. John Kasich echoed Portman's concern about health care costs and cited the Obama administration's “federal takeover of state insurance markets,” among other criticisms. “Proponents of the ACA created the impression that many Americans are trapped by pre-existing conditions, and are sick and unable to afford good health insurance,” he said. “They leveraged this view into a domino-effect of regulations: guaranteed issue to address pre-existing conditions, an individual mandate to mitigate the cost of guaranteed issue, a federal subsidy to mitigate the cost of the individual mandate, and tax increases to pay for the subsidy. In truth, most working Americans already had secure coverage, including many millions with expensive health conditions.”

Other recent numbers, though, tell a different story. In October, HHS reported benchmark plans in Ohio would increase on average by 2 percent in 2017, less than the 25 percent average increase predicted across the 39 states on the federal marketplace. Costs were expected to be kept in check by competition (despite reductions, most Ohio counties still offer plans from multiple insurers) and the statewide Medicaid expansion. Some areas in Ohio were even projected to see a decrease in rates, with an analysis by the nonprofit Kaiser Family Foundation (KFF) forecasting a 2 percent decrease in Cleveland.

Nationwide, projected premium increases varied greatly, with some Arizona residents looking at a 145 percent increase while Rhode Island citizens expected to see as much as a 14 percent decrease, according to KFF analysis. Across the board, rate increases were largely expected, owing to the rising cost of medical care and to market correction after initial prices for Obamacare came in much lower than expected. Following recent increases, 2017 premiums now more closely align with what the Congressional Budget Office projected before the ACA was enacted.

Regardless, there are legitimate concerns about the rising cost of health care, with much of the current debate split between two camps: one that believes the current law can be improved upon, and another that believes it necessary to scrap the ACA entirely and start from scratch.

Gov. Kasich, Sen. Portman and President Trump are all calling for a repeal and replacement of the ACA, which may be a possibility following Congress' mid-January approval of a “budget resolution” to address funding for the ACA, and the president's Jan. 20 ACA executive order.

Given the many outspoken Republican officials, repealing the ACA has been framed as a partisan issue, but there are Republican recipients of Obamacare who are fearful of the future.

“It seems to be that a lot of these Republicans, especially at the higher-up levels, are just spewing the party line,” said Shannon Treynor, a self-employed lawyer and co-owner of the London State Theater in Madison County, Ohio. “I don't think any of them have any personal experience with how this actually works.”

Shannon and her husband, Rob, are registered Republicans who say the ACA allowed them to purchase the previously closed one-screen movie theater in 2015. Two years prior, Rob was laid off his reporting job with Madison Press, which had provided health insurance for him, Shannon and the couple's three children.

“He'd been on a zillion job interviews and had no prospects,” Shannon said. “My only criteria was, ‘Find a job that has health insurance.' And after two years, I said, ‘Fine, don't find a job with health insurance. [If] we can't get you a job, we're going to make you one.'”

After Rob was laid off, the family purchased comparable insurance through the Obamacare marketplace for approximately $800 per month. It was a significantly better experience than Rob's previous period of unemployment prior to the ACA. Shannon remembered they couldn't afford to purchase private insurance, which would have run as high as $1,500.

“We always ended up on the high-deductible [Health Savings Accounts] and then you forego any kind of preventive maintenance because everything's out of pocket in addition to your monthly premium,” Shannon said.

“The fact that I could get the same quality of insurance that we had when he was working instead of those ridiculous HSAs … meant we removed his job-hunting requirements,” she continued. “Then making our own employment was feasible.”

If the ACA is repealed, the family will return to HSA coverage, Shannon said. “Our health would be compromised. We wouldn't have any kind of dental coverage again, we wouldn't have any kind of vision coverage again [and] we would go to zero preventative-maintenance appointments,” she said.

During a mid-January interview, Shannon seemed relatively confident that they wouldn't lose the theater. “We would do everything possible to stay open,” she said.

But in a follow-up email to Alive following President Trump's executive order, Rob was more apprehensive, citing speculation that tax credits subsidizing premium costs could be taken away, which would drive their monthly insurance payment up to $1,500.

“At this point, we do not know how long we will be able to sustain coverage at that price,” Rob said. “It may require me to find employment with an employer that will absorb some of those costs, which would mean closing the theater. That's not an option we'll take lightly, but I cannot discard it entirely, either.”

As citizens brace for the impact of the possible repeal of the ACA, Republican officials are promising a smooth transition and a more effective replacement plan.

“I support a transition period that would maintain premium subsidies and Medicaid coverage through at least 2017 in order to ensure that all affected individuals will have time to adjust to the new system and that no one loses coverage unexpectedly,” Sen. Portman said. “And as part of our [replacement] plan we should address issues like pre-existing conditions, Medicaid coverage, treatment for opioids and mental health care and a host of other issues.”

“Opponents have had seven years to come up with a replacement plan and they haven't produced anything yet,” Sen. Sherrod Brown said in an email to Alive. “Throwing Ohioans off of their health care and asking them to simply trust that everything will be alright is outrageous. Instead of creating chaos by kicking people off their health insurance and forcing premiums to skyrocket for everyone, we should be improving the law and making health care more affordable and more accessible for all Americans. Congress should be working instead to reduce prescription drug costs, strengthen Medicare, and protect Medicaid.”

As the government struggles with how to remake the health care system, the public is not staying quiet. Since Congress' budget resolution vote, people have been voicing their support for the ACA through efforts like the #SaveACA Twitter campaign and the national Save My Care bus tour, which features commentary from medical professionals and community leaders in support of the ACA, and testimonies from people who depend on the law.

“We have heard from elected officials that Ohioans sharing their stories makes a difference,” said Antonia Webb, state director of For Ohio's Future and an organizer of the Jan. 30 Columbus Save My Care bus tour stop. “In fact, Sen. Portman's office put out a request to hear ACA stories. As the future of the law is debated, we need Ohioans to share their stories [so] that lawmakers understand the impact of repealing the ACA.”

For many in the arts community, losing Obamacare would mean giving up a sense of pride in being able to take responsibility for their health.

“I understand self-employment is a choice [and] being a musician is a choice,” Paetsch said. “But … this is who I am, this is what I do. I don't have a choice so it's not like I'm standing up and saying, ‘I'm gonna be a musician. You guys figure it out.' I'm saying, ‘I want to be a musician. I want to take care of myself. Please help me.'”