When Your Health Coverage Hangs by a Thread
What artists need to know about the health insurance chaos coming our way
The ground is shifting under our feet again.
I've worked in healthcare since I was 14 years old. I've seen so many changes, so much suffering, so many people who didn't realize what options they had. So many people fighting systems that weren't designed for them.
I've been digging into what the Big Beautiful Bill means for artist health coverage, and honestly? It's a mess. But not the kind of mess we can ignore until 2027. The kind that requires action now.
All I can say is: be prepared. Get help navigating the systems when you need it. Work together with others to figure this out. Stock up. Be ready.
Here's what's happening: the enhanced premium tax credits that made ACA marketplace plans affordable are expiring at the end of 2025. Without these subsidies, the average marketplace enrollee will see premiums rise by 75% starting in 2026, according to health policy experts at KFF¹. That $200 monthly premium becomes $350. That $400 becomes $700.
And this is before the Medicaid work requirements even kick in.
The Numbers That Matter
More than 22 million people—92% of ACA enrollees—received federal subsidies in 2025 that reduced their premiums by an average of $705, according to KFF research². For artists scraping by on $30,000 a year, that $705 difference is the gap between having coverage and going without.
A family of four making $85,000 would face an additional $313 monthly premium increase plus a $900 increase in their out-of-pocket maximum, as detailed in an April 2025 Center on Budget and Policy Priorities analysis³. For individual artists making half that, the math gets brutal fast.
The Congressional Budget Office estimates 4 million people will lose health insurance just from the premium increases⁴. This is separate from the 12 million expected to lose Medicaid coverage.
What's Actually Available Right Now
Artist-Specific Programs That Still Work
The Entertainment Community Fund (formerly The Actors Fund) runs the most comprehensive artist health insurance program in the country⁵. Their Artists Health Insurance Resource Center provides free workshops, unbiased guidance, and enrollment assistance nationwide.
They offer:
Free health insurance counseling by phone or Zoom
"Every Artist Insured" workshops (Thursdays 12:30-2pm ET for NY/NJ residents, first and third Tuesdays 12-1:15pm PT for CA residents)
Enrollment assistance for ACA marketplace plans
The Friedman Health Center in NYC for primary and specialty care
Graphics Artists Guild participates in the Book Industry Health Insurance Partnership, offering members access to group health coverage options including ACA plans, Medicare supplements, and short-term coverage⁶.
Contemporary Art League in Los Angeles provides California-based art workers with free, confidential help navigating Covered California through their "Help with Health Insurance" program¹³. As a cooperative trade organization building solidarity among LA County art workers, they define art workers broadly as "anyone working (whether compensated or not) in creative communities and/or the creative economies."
Regional Artist Organizations:
St. Louis Volunteer Lawyers and Accountants for the Arts runs an "Every Artist Insured" campaign helping artists navigate the health insurance landscape¹⁴
ArtsLink NB (New Brunswick) offers "The Arts & Entertainment Plan®" providing extended health care, dental, prescription drugs, and life insurance specifically designed by and for the artistic community¹⁵
State-Specific Resources:
New York offers Medicaid ($0) and the Essential Plan ($0-$20/month) for very low-income artists through NYSOH
California has expanded Medi-Cal with more generous income limits
Massachusetts has HealthCare for Artists with a dedicated hotline: (800) 272-4232
The Brutal Reality of 2026 Marketplace Plans
Early rate filings show some of the highest premium increases in over a decade. Rhode Island's insurance regulator noted the "requested rate increases are the highest in over a decade," while Maryland's said they "are the highest since the implementation of Maryland's reinsurance program in 2019," according to analysis by the Center on Health Insurance Reforms⁷.
Insurance companies are already bailing out—Aetna announced it's exiting ACA marketplaces entirely after 2025, affecting 1 million people across 17 states⁸.
Insurers expect that healthy people will drop coverage due to higher costs, making the remaining risk pool sicker and driving premiums even higher. Blue Cross Blue Shield of Vermont warned that "some healthy individuals with lower claims than average will forego health insurance due to the decrease in subsidies, this will cause the premiums to increase by 6.6 percent"⁹. It's a death spiral in slow motion.
But here's the thing—even expensive marketplace coverage might be better than nothing. And if you're losing Medicaid, it might be your only option.
Emergency Preparation Steps
Do This Before December 31, 2025:
Get current on preventive care. Annual checkups, dental cleanings, eye exams, prescription refills. If you're going to have a gap in coverage or higher costs, do everything you can while it's still covered.
Document your medical history. Get copies of test results, specialist reports, prescription lists. If you end up switching providers, you'll need these records.
Research your local options now. Don't wait until open enrollment chaos. Know what plans will be available in your area and what they'll cost without enhanced subsidies.
Build a healthcare emergency fund. Even $500 can cover urgent care visits or prescription costs during coverage gaps.
Income Strategy for ACA Eligibility:
For artists with irregular income, you can estimate earnings when applying and update if your situation changes. Estimate conservatively to maximize subsidies, but don't lie—you'll have to reconcile at tax time.
Income timing matters. If you have a choice about when to receive a large payment or commission, consider how it affects your annual income calculation for subsidy purposes.
Alternative Coverage Models
Healthcare Sharing Ministries
These aren't insurance, but some artists use them as a stopgap. Members contribute monthly amounts that go toward each other's medical bills. Cheaper than traditional insurance but with significant restrictions:
Usually require religious affiliation
Don't cover pre-existing conditions
No guarantee bills will be paid
Don't count as ACA-compliant coverage
Only consider this if you're young, healthy, and understand the risks.
Direct Primary Care
Some artists are joining direct primary care practices where you pay a monthly fee ($50-150) directly to a doctor for unlimited office visits, basic lab work, and prescription discounts. This covers routine care but you'd still need catastrophic coverage for emergencies.
Community Health Centers
Federally Qualified Health Centers provide care on a sliding fee scale based on income. Not insurance, but affordable primary care and often dental services. Use the health center finder at findahealthcenter.hrsa.gov.
Mutual Aid and Collective Solutions
Artist Emergency Funds: Some local arts communities are creating mutual aid funds specifically for medical emergencies. Monthly contributions from members, distributed when someone faces a health crisis.
Medication Access Programs: Most pharmaceutical companies offer patient assistance programs for expensive medications. GoodRx and similar apps can help with routine prescriptions.
Dental and Vision Cooperatives: Some artist communities are negotiating group rates with local providers. Not insurance, but discounted services for members.
Barter Networks: Trade your skills for healthcare. Graphic design for dental work. Photography for massage therapy. It's not a complete solution, but it helps.
What We're Up Against
The enhanced premium tax credits expiring isn't an accident. It would cost an estimated $335 billion over the next decade to extend them—money the Republican-controlled Congress and Trump administration are unlikely to spend while seeking budget savings to offset tax cuts¹⁰.
States don't have the money to replace federal aid. Pennsylvania, for example, would need $500 million annually to maintain current subsidy levels, according to Devon Trolley, executive director of the state's exchange¹¹. As Hemi Tewarson, executive director of the National Academy for State Health Policy, told Stateline: "They are all assuming that they would just have to absorb the loss of coverage across the population"¹².
We're on our own here.
The Long Game
If You're Young and Healthy:
Consider catastrophic coverage if it becomes available. High deductible, low premium, covers major disasters. Pair it with a health savings account if possible.
If You Have Chronic Conditions:
Start building relationships with community health centers now. Research patient assistance programs for your medications. Consider relocating to states with better Medicaid programs if your condition is serious enough.
If You're Approaching 65:
Understand Medicare eligibility and timeline. The Entertainment Community Fund offers Medicare workshops specifically for artists.
Document Everything
Keep detailed records of:
All medical expenses (even if you can't afford treatment)
Income documentation for subsidy applications
Coverage gaps and the reasons (for future applications)
Any discrimination or problems with coverage denial
Artists are particularly vulnerable to being classified as "non-credible" applicants because of irregular income. Paper trails matter.
What's Next
The next few months will determine what health coverage looks like for artists through the rest of this decade. The ACA marketplace open enrollment for 2026 coverage starts November 1, 2025—right when enhanced subsidies are set to expire.
This isn't about finding the perfect plan. It's about having something instead of nothing when the system collapses around us.
What's your backup plan? Are you prepared for premiums to double? Do you know what community resources exist in your area? Have you gotten current on preventive care?
The artists who survive this transition will be the ones who planned ahead, built community connections, and didn't wait for someone else to solve it.
We've weathered worse. We'll get through this too. But not by pretending it's not happening.
How are you preparing for the coming health insurance changes? What resources have you found (or created) in your community? I'm genuinely curious about what's working on the ground level.
Information current as of July 15, 2025. Healthcare policies and premium costs are changing rapidly—always verify current information with official sources and qualified professionals.
Sources
KFF Health Policy Research - "Why ACA health insurance premiums may see 'sharp' increase in 2026" - https://www.cnbc.com/2025/07/11/aca-health-insurance-premiums-increase.html
KFF Premium Tax Credit Analysis - https://www.cnbc.com/2025/07/11/aca-health-insurance-premiums-increase.html
Center on Budget and Policy Priorities - "Proposed ACA Marketplace Rule Would Raise Health Care Costs for Millions of Families" - https://www.cbpp.org/research/health/proposed-aca-marketplace-rule-would-raise-health-care-costs-for-millions-of
Congressional Budget Office estimates referenced in multiple policy analyses
Entertainment Community Fund Artists Health Insurance Resource Center - https://entertainmentcommunity.org/services-and-programs/artists-health-insurance-resource-center
Graphics Artists Guild Health Coverage Program - https://graphicartistsguild.org/product/member-bihip-health-coverage/
Center on Health Insurance Reforms (CHIRblog) - "Early 2026 Rate Filings Show Marketplace Policy Changes Contribute to Eye-Popping Rate Increases" - https://chirblog.org/early-2026-rate-filings-show-marketplace-policy-changes-contribute-to-eye-popping-rate-increases/
CHIRblog rate filing analysis
Peterson-KFF Health System Tracker - "Early indications of the impact of the enhanced premium tax credit expiration on 2026 Marketplace premiums" - https://www.healthsystemtracker.org/brief/early-indications-of-the-impact-of-the-enhanced-premium-tax-credit-expiration-on-2026-marketplace-premiums/
New Jersey Monitor - "Millions will see rise in health insurance premiums if federal subsidies expire" - https://newjerseymonitor.com/2024/12/11/millions-will-see-rise-in-health-insurance-premiums-if-federal-subsidies-expire/
New Jersey Monitor - Pennsylvania exchange analysis
National Academy for State Health Policy via Stateline reporting
Contemporary Art League - "Help with Health Insurance" - https://www.contemporaryartleague.com/health
St. Louis Volunteer Lawyers and Accountants for the Arts - "Every Artist Insured" - https://vlaa.org/get-help/every-artist-insured/
ArtsLink NB - "The Arts & Entertainment Plan®" - https://artslinknb.com/resources/health-insurance-plan/
The Brand Library - Opulent Mobility Exhibition 2025
Thank you for this vital information Kristine—you continue to amaze with your research and round up abilities!