The Health Alliance for Austin musicians to the rescue?
On the rainy evening of April 20, HAAM is served. The South Chicon neighborhood streets are flooded by cars and rainwater, but that doesn't stop local musicians without medical insurance from lining up on this first night of eligibility for the Health Alliance for Austin Musicians. The new SIMS headquarters, a renovated house in East Austin, serves as makeshift launching pad for this inaugural endeavor. Within minutes of opening its doors after hours, SIMS's waiting room is SRO. A plate of sandwiches, plastic chairs, and an old boom box compete for space as local artists fidget while awaiting their chance in a screening room.
The vibe is laid-back, the setting resembling a film casting call rather than a medical clinic. As the wait settles in, a veteran Austin singer-songwriter arrives, prompting one fellow Austin guitarslinger to joke, "Is he auditioning, too? Because if he is, I'm outta here!" Jokes amongst longtime colleagues aside, the musicians waiting today and every day after are competing for the same 500 slots. While some critics ponder the benevolence of a system that could end up turning away and/or limiting the kind of medical care its clients have needed for decades, everyone agrees HAAM is the start-up to watch. For HAAM itself, this night begins what could easily be considered a matter of life and death in the long-suffering health care crusade.
Feel Like a Number
Tuesday, March 15, was prime-time media real estate for the SIMS Foundation, Seton Health Care Network, and St. David's Hospital to hold a press conference. In the middle of South by Southwest, these three local health care entities proclaimed they were forming the Health Alliance for Austin Musicians. The mission, they announced, is simple: delivering health care to Austin musicians who can't otherwise afford medical insurance.
The responsibilities were being split three ways: SIMS (Services Invested in Musician Support) would continue focusing on mental health, Seton would provide primary care, and St. David's would add dental services. SIMS was charged with determining eligibility, which involves an application process based around three main criteria: local residence, music industry references, and no insurance. In all, HAAM's magical resource allocation number is approximately 500 musicians. Dental and mental care extends to musicians' spouses and children.
Few question HAAM's being a very real boon for area musicians without institutionalized health care, but are the projected 500 slots enough? A similar setup in another live music capital, New Orleans Musicians' Clinic, claims to have treated some 800 musicians since its inception in 1998, believing that number to be indicative of the ceiling for such programs. Locally, people want to know what will be done once the ceiling has been hit, and the HAAM players are among the first to wonder. Hopefully, say representatives of all three HAAM principals, 500 enrollees is a healthy start.
SIMS's development coordinator Emily Erickson: "In 2004, SIMS served 330 musicians and family members. Based on our success fundraising, we expect to provide mental health services for at least 500 and possibly more musicians and their immediate family members this year."
Beth Atherton, director of health care access, referral, and enrollment for Seton: "Seton is providing access for 500 musicians to receive preventive care through the Seton Musicians Clinic. When 500 are enrolled, we will close [registration]. However, we will continue to assist anyone in getting screened for other programs for which they are eligible and will still assist musicians and their families in finding other limited resources once the clinic is closed. It is hoped that once we find preventive care services for the first 500 that we can raise the dollars needed for more."
St. David's spokesperson Kammi Siemens: "St. David's has offered 500 patient slots to musicians and their families during June, July, and August. If we book all of the days we have reserved for HAAM during the summer, the capacity is closer to 800. We have the potential to provide additional services during school holidays and breaks, and in summers to come, with additional dollars."
In the HAAM equation, primary care will naturally be of primary interest to applicants. What kind of limits will Seton impose and how will they determine who pays for what? According to Diana Resnick, VP of community care for the Seton Healthcare Network, the hospital will determine which doctors in their network patients should be referred to, whether to mend a broken limb or cure a rash. Things like dialysis or complex procedures like kidney surgery would not be covered, though Resnick assures that if musicians need something like open-heart surgery, Seton will assist them with finding a place to get it done.
"We get them what they need, and then we figure it out in terms of payment," she explains. When a musician applies for eligibility, HAAM will determine a number classification for them between one and five. This number will help care providers figure out the sliding scale of co-pay.
"For example, a plain film X-ray could cost from $5 to 15, but an MRI or CT scan could cost the musician anywhere from $20 to 50," Atherton explains.
"It's not insurance I don't want to call it 'insurance,'" concludes Resnick, though many of the easy analogies offered by HAAM compare it to medical insurance. "There's no problem with what I call 'frequent flyers.' The only way you don't come back is if you disenroll."
If someone does decide to disenroll, for whatever reason, their slot becomes available to someone on the waiting list. The 500 musicians enrolled are expected (and encouraged) to make multiple visits. There's no set limit, only until the money runs out. Currently, the HAAM budget is a little more than $1 million in donations from the three entities.
"Additional monies come from donors such as SXSW, Time Warner, and the generosity of HAAM board members," says HAAM board member Robin Shivers, a fixture of the Austin music industry. "HAAM needs to raise money to complete funding of first-year operating expenses and to expand capacity and services for Austin's uninsured musicians."
It was actually Seton's Diana Resnick who played a crucial role in getting HAAM rolling. Six months ago, the head of the New Orleans Musicians' Clinic suggested a similar program be offered in Austin, so Resnick immediately thought of Austin's influential (sometimes controversial) powerhouse of musician mental health, SIMS. After enlisting the help of Robin Shivers, Resnick began devising a way to service the estimated 17,000 working local musicians.
"Musicians don't see themselves as the working poor, so they want another way of access," explains Resnick. The participants and service package began to take shape, as did an advisory board. One of those board members communicating the need for assistance was Asleep at the Wheel's Ray Benson, also on the board of St. David's.
"For us," says St. David's Foundation COO Carol Clark, "it's part of supplementing the community. Musicians are so important to Austin."
When St. David's committed to providing dental care, it was decided service would be offered in an unorthodox manner: dental vans. St. David's currently operates three vans at a cost of $400,000-500,000 each. Each van is equipped with fully functioning dental equipment and two chairs for patients, who can receive everything from X-rays and fillings to a root canal. The vans' main purpose: aiding the students of AISD. This is why St. David's won't actually begin full service until June, when regular school sessions are over.
"Since we visit each school during the regular school year, we catch the summer school kids during the regular term," says Clark. "We do provide some service to children in the summer, especially for children whose mouths require a lot of time in the dental chair. But we don't need all three vans to care for children during the summer, thus the capacity to take on adults."
In other words, other than in summertime, the vans will only be available during school holidays and after hours. What if an eligible musician needs a dentist while school's in session?
"We certainly have same-day capabilities, [though] dental emergencies probably can hang on for a few hours," claims Clark. "If it needs immediate attention, they probably need an emergency room."
To get some practice on grownups, St. David's had trial runs with volunteer musicians during the spring break holiday. Local singer Carolyn Wonderland was one of those volunteers. Not only is Wonderland without medical insurance, she estimates she hadn't seen a dentist since her wisdom teeth were removed years ago.
"I'm excited by it," Wonderland says on the eve of HAAM's official launch. She's one of the musicians currently applying to HAAM for full benefits. When asked about her health insurance history, she replies, "Never in my adult life."
"All along there's been the idea that we need to help musicians overall, but we never had the resources," says SIMS Executive Director Mary Louise Lopez. "About the time we started exploring it, Seton approached us."
SIMS has existed for a decade as the grand poobah of Austin musician care, raising funds with high-profile supporters and events. Founded in the wake of Pariah bassist Sims Ellison's suicide (see "Every Day of Your Life," Music, July 7, 2000), it's no surprise the organization's attention doesn't stray from mental health care. Because of its extensive experience with the music scene of Austin, SIMS determines musicians' eligibility for HAAM.
"Our priority is that mental health care should not be impacted negatively," says Lopez. "We're making sure that if we get into deep waters we can take care of it."
SIMS will be the only one of the three HAAM principals that will have to walk a tightrope between two sides of musician care. For example, if a musician is already involved with SIMS, they still have to apply for HAAM separately. Lopez also makes it clear that the six-figure proceeds from KGSR's annual Broadcast CD series will be used for mental health exclusively, rather than distributed for HAAM.
Unbeknownst to locals, perhaps, SIMS isn't the only resource of its kind around the country. In Athens, Ga., for example, there is Nuci's Space, founded by the family of Nuci Phillips, who killed himself in 1996 after battling depression. In addition to mental health care, Nuci's Space also offers practice space for musicians, incorporating a special offshoot program for students at the University of Georgia. In Los Angeles, there's the longstanding Sweet Relief Musicians Fund, founded in 1994 to offer financial assistance to musicians with disabilities or age-related problems. It has spawned a series of popular benefit albums and concerts thanks to the support of bands like R.E.M., Pearl Jam, and more.
In the case of HAAM, again, the impetus originates from the New Orleans Musicians' Clinic. NOMC Outreach Chair Bethany Bultman describes her staff as "nymphomaniacs in a whorehouse," adding, "We're utterly passionate about what we do, and thus, either we're full-time volunteers or we work for slave wages."
Bultman is working toward a national network to help facilitate projects like HAAM and health care organizations such as SIMS. NOMC has already partnered with Sweet Relief and the national Recording Academy's MusiCares program on various projects. Bultman's also reached out toward the Jazz Foundation of America on developing a sister clinic in New York City.
"The more musicians' clinics there are," Bultman adds, "the more power we all have to save American musicians and change the health care indicators in our country."
Meanwhile, national organizations like music publishers BMI and ASCAP offer support for their members through MusicPro Insurance. With MusicPro, musicians can receive tour liability coverage, which varies depending on factors such as: number of shows, attendance capacity of each show, special effects, etc. There's also Studio Liability insurance, and MusicPro also provides standard life insurance and health insurance. Despite an effort to target musicians in need of medical care, MusicPro Insurance requires that artists pay quite a bit out of their own pockets.
"There's never been any progress made nationally," states Dave Marsh, author, Chronicle contributor, and arguably the music industry's foremost expert on the subject of musician health care. He agrees that a lack of community between these organizations has created dynamic hurdles on the way to achieving what's best for the artists. "Isolation throws up way more flags."
Marsh is skeptical about what HAAM can accomplish for the local music scene, citing the recent arrival of MusiCares into Austin as more significant. The MusiCares Foundation was founded in 1989 by the Recording Academy as a means of providing financial aid to members of the billion-dollar music industry still without insurance. The "heart and soul" of MusiCares is the Emergency Financial Assistance Program, which helps with medical expenses but also includes assistance for things like paying rent or utility bills. MusiCares also runs an Addiction Recovery Program to provide referrals and some financial aid for overcoming substance abuse. SXSW is one of many industry events in which MusiCares hosts a "Safe Harbor" room to offer a support network for traveling patients.
The Texas Chapter of the Recording Academy has sponsored MusiCares fundraisers in Austin for a while now. They even host musician health fairs, providing flu shots as well as cholesterol and blood pressure screenings to local artists. In late March, the academy announced that it was hiring a part-time staff member to create a MusiCares presence in Austin. The responsibilities will include handling calls and working with venues for greater outreach. While there's no formal tie between MusiCares and HAAM, the Recording Academy hopes the two can partner.
"Where MusiCares comes in is to be a safety net, providing assistance when someone's in crisis," says Wendy Morgan, executive director of the Texas chapter. Morgan suggests that MusiCares in Austin can help provide financial support for a musician still in recovery from a HAAM-related medical procedure.
It would take at least such a partnership, according to Marsh, to address serious health care issues for musicians.
"Ask Alejandro Escovedo and Ray Benson how many times they have to go to the doctor," says Marsh, referring to both musicians' battle with a growing industry hazard, hepatitis C. "To single out and treat anyone with a serious illness in the music industry, without health insurance, it would take hundreds of thousands of dollars per case."
In the days following the first night of appointments, the HAAM reps are pleased with how things went.
"All went really well," says Emily Erickson of SIMS. "We're still getting the kinks out of the interview process."
This includes adding more personnel and another computer. For the time being, SIMS estimates they will interview between 150 and 200 candidates by the end of May. After that, school is out, and HAAM will have its full resources available. Not only will each organization be working full-force, HAAM will be the glue. In the red tape realm of health care, unity is the biggest issue of all.
"We're figuring out how to work more efficiently," says Mary Louise Lopez of SIMS. "Seton is going to allow one of their social workers to spend more time on HAAM, and she will spend half a day with us here at SIMS five days a week. That should help us juggle everything much better."