Theater community grapples with health costs

September 9, 2009 (CHICAGO) As she watched the welt on her face balloon, Vignola said she weighed the necessity of an emergency room trip against the cost. It took convincing from her mother, but she eventually sought treatment at Northwestern Memorial Hospital. She went home the same day with a prescription and soon recovered from a mild concussion.

About a month later, she started receiving notices from the hospital and her insurance company, from which she buys coverage independently, and learned she owed thousands of dollars exceeding what she could afford.

Vignola's insurance failed to cover her medical costs as she thought it would. She said coupled with the financial strain, purchasing individual insurance and understanding the plans can be purposely confusing

"I understand that insurance companies have to make money. And I understand that it's a part of the business. But I really wish that insurance companies were more clear about what they're going to cover. I thought that I was covered," Vignola said. "Thank God I didn't get an ambulance."

The Union and the Numbers

Vignola is a member of the Actors Equity Association, the major theater union in Chicago. But she doesn't qualify for health benefits because she has not worked enough jobs recently.

"Of my friends and professional acquaintances, I know very few who are fully insured and can afford to be fully insured," Vignola said. "If they are insured, they usually have a husband or a wife who has a 'regular' job."

The union is a sought-after avenue to insurance in theater. But an AEA member must work 12 weeks in a one-year period to qualify for six months of health coverage. With an average theater show running four to five weeks, it typically takes at least three gigs annually to qualify for the insurance.

And finding theater work, especially now, is tough.

"They're doing probably the same number of shows; what they're doing are smaller shows," said Kathryn Lamkey, central regional director for AEA. "The show that might've had 15 actors, now they've decided to do a show with eight."

The League of Chicago Theatres estimates that for every local actor in Equity, there are three non-unionized actors. And only about 300 of the 1,400 Equity members in the Chicago area actually qualify to buy health insurance via AEA.

"We've cut back tremendously on the number of individuals who qualify for health coverage over the last few years," Lamkey said. As of 2007, the union also charges actors a quarterly fee for coverage, subsidizing the money theaters already pay into the plan.

Meanwhile, salaries in theater haven't kept pace with the average cost of living, Lamkey said. The typical AEA member makes an average of $21,000 a year. For the last two decades of negotiations, Lamkey said, AEA has had to defer salary raises into health care costs.

On August 3, the AEA posted a call-to-action on its Web site for members, asking them to write their elected officials in support of health care reform that includes an inexpensive public health care plan. Actors Equity has been a proponent of universal health care for 18 years.

"Health care is not only just a social issue for us, it's a definite, economic issue for our membership," Lamkey said. "And we believe it is vital for our members, who are really representative of the entire country. They're like everybody else. Sometimes we want to say we're very special, and in some ways I suppose we may be special. Economically, they are the same problems that the rest of America faces."

2006 - 2009: An Insurance Odyssey

Keith Survillas, 30, an aspiring actor, has moved to three different states in as many years, driven by a search for reliable, state-run insurance.

Between Massachusetts, Illinois and Arizona, Survillas found his biggest challenge was simply finding quality coverage, especially with his heart and knee problems.

In Massachusetts, the public aid was helpful, but there were limits to what he could have treated, he said.

"Everything was covered at a minimum," Survillas said. "Medicines were changed to minimum dosages. I was always getting generics, but they changed the types of generics I was getting. And I saw doctors less frequently. I was at their mercy of what they covered and what they allowed me to do."

Survillas called Massachusetts' health care a Band-Aid approach, saying the problems may not have gotten worse, but they didn't get fixed either.

Survillas said he tried applying for publicly funded health insurance when he moved back to Illinois in 2007. But after four interviews about his financial and medical history -- sometimes with the same counselor twice -- he received two letters in the mail. One stated that he'd been approved for state coverage and granted him a debit card with money for his health needs. A second letter stated he'd been denied and had to return the debit card. Survillas gave up applying for state aid here.

He then moved to Arizona, where he learned that applying for state aid was much simpler, with more comprehensive coverage available. Survillas said in Arizona he's been able to see specialists, including a cardiologist, and said the state will cover a future knee replacement.

Survillas estimates he's spent about three-quarters of his time in the last few years simply applying for health insurance and seeking alternatives. During that time, he was also looking for a job.

"I did a lot of work looking for work, but I wasn't working a lot," Survillas said.

The Lewis University graduate and Chicago native said he'd love to return to his home state, but his experience with the state's public aid is keeping him at bay.

"I love Chicago, and I would come back to my home city and home state if it had a well-run insurance program," Survillas said.

Non-Profit Options

Both Survillas and Vignola expressed trepidation toward county health services. And the uninsured and under-insured still have many options outside the current offering of government-run services.

After failing to secure state-run insurance in Illinois, Survillas turned to a non-profit center, the Howard Brown Clinic, for his health care needs.

"They're a one-stop shop," Survillas said. "They treated everything from mental health issues to any physical ailments, and everything I received was top notch."

Daliah Medhi, R.N., clinical operations manager for Howard Brown, says the clinic serves both the insured and uninsured, with patients split about 50-50. She says the popularity of the clinic could hinge on its treatment of the uninsured just like the insured patients. Uninsured patients are billed on a sliding scale, based on what they can afford. They're also given appointment slots like a regular doctor's office, instead of waiting for long periods of time on a walk-in basis.

Medhi says the clinic has traditionally always served people employed in the arts, as well as restaurant workers and bartenders -- people without full-time work or full-time benefits. But she says with the economic downturn, the clinic has seen an uptick of unemployed people from all professions.

"The theater community has always been facing this problem of chronic un-insuredness, and I think the rest of society is catching on to what the theater community's been dealing with for decades," Medhi said. "As people lose insurance, everyone has a friend, relative, neighbor, who is uninsured, and I'm going to guess people in the theater community are like, 'Oh finally, people understand what we're going through.'"

After receiving her bill, Vignola called Northwestern, hoping to negotiate a payment plan. Instead, she was assessed to be so under-insured and incapable of paying what she owed, that Northwestern excused the entire bill, in accordance with its financial assistance programs.

Vignola said she was shocked to discover she could receive financial help even though she had insurance.

"I always heard that if you didn't have insurance, there's charity care or whatever they call it. But I had insurance," Vignola said. "So I was like, I guess I'm going to have to pay this. [But] they will apparently help people who are under insured."

"Both uninsured patients and those with medical insurance but who may be left with balances they cannot afford to pay may qualify," says a financial resources brochure on the NMH Web site.

Medhi said some form of health care reform is necessary because people forgo treatment for deadly diseases out of fiscal worry.

"I had a woman come in and say she felt a lump in her breast, but [said], 'What's the point of getting a mammogram? There's nothing I can do about it anyway if I get a cancer diagnosis,'" Medhi said. "There are programs, but if nobody tells her about the programs, she was willing to ignore what she knew to be true because of the fear of the cost."

To Act or Not to Act

Survillas and Vignola represent divergent approaches to reconciling theater and health coverage.

Survillas says his ultimate goal is to first find a full-time job, be it in theater or another field, in order to get good health coverage.

"I'm not the kind of person who would say, 'Well, my goal is to mooch off as much as I can.' My goal is to get a job with private insurance," Survillas said. "There's a small percentage of people out there who will take advantage of the system. There's always going to be people who will take advantage of something that's free."

He said once he has a full-time job, he can actually focus on his theater career. He said he'd like to work in New York City but doesn't like the state's public health care plan.

Survillas said he actually opposes a federal public option but favors state-run coverage, as long as it's done right.

Vignola, who lacks any chronic physical ailments, has decided to pursue theater full-time, working in the training center of ComedySportz in Chicago and performing with improv troops.

"It's kind of a catch-22. I can go back to my sales job, and maybe do improv once or twice a week, but then that career that I really love is not going to go anywhere," she said.

Vignola said she'd like to see the nation head toward a public option but knows it's a hard sell.

"It seems like universal health care would be something that would work. Will the country ever go for it? I wish. Would I jump on it? Yes," she said.

Lamkey says the decision for many actors to quit following their dreams can often come at an older age, when the financial challenges of raising a family can overwhelm an actor scraping by show to show.

"One of the difficult things is to see two actors, who are married to each other, who have made careers in theater for the last few decades, doing passable. And they're not getting rich, but they're working quite steadily and find now with the cost of family health care, and they have children, and they're trying to raise those children, that it is making it a difficult choice for them to stay in their chosen career," Lamkey said. "Our insurance is single-coverage health insurance when it's there. So they have to purchase insurance for their spouses or for their dependents. And that's extremely expensive. And many of them look at it, because of the intermittent nature of their work, it makes it difficult to say, 'I'm going to continue in this job and stay an actor for my entire life.'"

But she also added that people in theater, typically driven by a passion for the art from a young age, often find a way to persevere as long as possible

"Actors are used to adversity and have a tendency, I think, to be able to find the silver lining in almost any cloud," she said. "They question when we go into negotiations with our bargaining partners what it's going to mean to our bottom line and wish that we could do better."

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