AGMA’s Health Insurance Problem, and How to Solve It

 

Unions exist to identify and correct imbalances. We are a collective engine for fairness. By standing together, our strength at the negotiating table balances the strength of the administrations of the companies for which we work, and our agreements are more equitable as a result.

We work hard at our respective crafts, and in exchange for our labor, we should expect the classic union protections that lend dignity to our lives: fair wages, healthcare and pension.

But it’s not just our responsibility to balance the strength at the negotiating table between management and members. If we identify an imbalance within our own ranks, we must correct that, too. The loss, six years ago, of the ability of AGMA members to use Health Fund Plan B contributions to reimburse health insurance premium payments created an imbalance, and the path to rectifying this imbalance is clear. AGMA can and must bring an accruing health insurance benefit to all of its members. Anything short of that isn’t just unfair – it’s immoral.

 

The Ideal Health Insurance Policy

Singers know when they need to see an otolaryngologist. Dancers know when they need to see a podiatrist or orthopedist. Since many of our members travel extensively for work, receiving care wherever they happen to be is crucial. Thus, the optimal health insurance policy, for the majority of AGMA’s membership, offers nationwide in-network care without the need for all care to be coordinated by a primary care physician.

It should also offer coverage for out-of-network care. But having this in tandem with a nationwide network is important; if out-of-network coverage is all you have when you travel, the cost for care can still be quite high. Not only will you face a higher deductible and lower reimbursement percentage, but you will often be billed for the full difference between the contractually agreed-upon price for an in-network provider and whatever price the out-of-network physician is free to charge. This situation effectively guarantees an additional and unpredictable out-of-pocket burden to you.

A PPO with a major insurance carrier is the optimal policy; a BlueCard participating BlueCross BlueShield policy, UnitedHealthcare, Aetna or Cigna come to mind. An EPO or a POS may also do the trick, but an HMO with a service area of a few surrounding counties is not something that serves us well unless we work year-round in the same city.

 

The Exchange Won’t Save Us…

Unfortunately, a policy like this isn’t necessarily available on the exchange. It depends in large measure on where you live.

For example, in New York City, there are ZERO insurance policies with either a nationwide network or out-of-network coverage available on the exchange. In Chicago, you can find a PPO with a nationwide network on the exchange, but it lacks agreements with the major hospital groups inside Chicago like Northwestern and Rush, such that you’d get better care in Chicago if you had insurance from Pennsylvania or Florida, and those who have insurance in Chicago receive better coverage when they are away from home than when they are home!

The inadequacy of the offerings on the exchange in the locations where many of our members live and work makes it all the more urgent that AGMA offer an alternative.

 

…And Only a Few of Us Can Enjoy Plan A Benefits.

AGMA’s current Plan A policy is a much better option than many of the offerings on the exchange. It offers a nationwide network, no referrals needed to see specialists, out-of-network coverage, and fairly low out-of-pocket costs. So, why not just make it possible for members to buy into the policy at full price?

Insurance underwriters set the price of the policy, and that price is determined in part by the pool of eligible plan participants. AGMA has an open-door admission policy that permits ANYONE to join. If we allowed members to buy in at the full cost of the policy regardless of the amount of work they were getting, premiums would skyrocket, because those with the greatest healthcare needs would overwhelmingly opt for Plan A.

At present, Plan A eligibility is determined on a company-by-company basis and is an all-or-nothing proposition. For example: At Lyric Opera of Chicago, if you work on a weekly contract for at least 16 weeks, they buy your Plan A policy for a full 12 months. However, at Los Angeles Opera, it’s 12 weeks for 12 months. This is great for young artists, weekly artists with a long enough contract, and choristers, but is of no benefit to itinerant artists.

 

The Cruelty of All-or-Nothing.

Consider this:

A member could work for Lyric Opera of Chicago for 15 weeks and Los Angeles Opera for 11 weeks in one season and qualify for NO HEALTH INSURANCE.

That’s what I mean by all-or-nothing. Meet the threshold with one employer and that employer pays for a full year’s insurance. Fail to meet that threshold and you are out of luck. This paradigm encourages employers to make casting choices that allow them to dodge health plan contributions by writing contracts just short of the minimum length whenever they can.

Plan A was never designed to serve the needs of our itinerant members. That’s what Plan B was for.

The Affordable Care Act did a lot of good. It really did. But one of the unintended consequences of the ACA is that it destroyed Plan B.

The ACA made it impossible for AGMA to offer reimbursement plans to anyone who is not offered enrollment in a group health plan. As a result, under most circumstances, AGMA’s members can no longer use Plan B contributions to offset the cost of their health insurance premiums.

 

The Solution: Accruing Eligibility

We’ve waited six years for AGMA to address the loss of Plan B’s primary function. It’s time for us all to recognize that the only viable path forward is to expand eligibility for Plan A by moving from an all-or-nothing paradigm to an accruing eligibility paradigm.

In an accruing eligibility paradigm, employers would make health fund contributions as a component of all the work we perform. Once an individual member reaches a specific threshold – income earned, weeks worked, or total health fund contributions made on their behalf – they would become eligible to receive a health insurance benefit.

Is this the right paradigm for AGMA? Overwhelming precedent suggests that it is.

Let’s focus solely on the entertainment unions. Accruing health benefits are offered by:

 

Actors’ Equity

SAG-AFTRA

SDC

DGA

WGA

AGVA

AFM Local 802

(New York)

IATSE

AFM Local 47

(Los Angeles)

Chicago Federation of Musicians

Local 10-208

Musicians Union of Las Vegas, Local 369 AFM

(in partnership with the Culinary Health Fund)

 

An accruing health insurance benefit is so prevalent within the labor movement that it’s impossible to ignore.

It’s what unions do.

 

We Can Do It, Too.

Unions that are less than half the size of AGMA have proved capable of sustaining this benefit model.

There is nothing holding AGMA back from following the lead of the majority of the entertainment unions – except for a lack of willingness to do the hard work that will make this change real.

Here’s what needs to get done.

Due Diligence
Union leadership needs to conduct significant amounts of research about what the optimal accruing benefit structure would be. There are many options available. For example:

  • AGMA could base eligibility on weeks worked (like Equity), total income earned (like SAG-AFTRA) or total health fund contribution (like SDC). Each of these approaches has benefits and drawbacks that would need to be carefully considered. AGMA may, for example, need to begin with eligibility determined by total health fund contribution and shift to a total income earned paradigm once all signatories begin making health fund contributions.
  • AGMA could go it alone or seek to partner with others in a combined health fund (similar to what the Las Vegas Musicians do).
  • AGMA could offer a single health insurance policy (like AGVA and our current Plan A), offer multiple policy options for the same cost (like Equity), or offer tiered policies with better coverage for higher earners (like SAG-AFTRA).

No Member Left Behind
We must ensure that members who currently receive their health insurance coverage through plans administered directly by their employers do not get shortchanged by this shift.

For some shops, that may mean making certain that there is an available union-administered plan that is as good or better than their current plan before asking them to consider switching. For others, it may be best for full-time employees to continue with their employer plan and bargain for health fund contributions only for the itinerant employees in that shop.

Across Union and Non-Union
Itinerant artists working both union and non-union gigs should have a fair chance to qualify for health insurance. AGMA should:

  • investigate making health fund contributions a mandatory component of the Guest Artist Agreement
  • consider making the Guest Artist Agreement itself mandatory when an AGMA member works in a non-union house
  • seek ways for members who work abroad to divert some of their foreign income to health fund contributions. Solutions include applying for membership in the Fédération Internationale des Acteurs to collaborate with leaders from other unions across the globe.

 

Getting to Work.

Providing AGMA’s members with an accruing health insurance benefit will require hard work. There’ll be difficult questions to answer and significant shifts in our bargaining priorities.

But A Voice for All believes that, after six years of inaction, our members should not have to wait another day to start fixing this problem.

A Voice for All is committed to bringing an accruing health insurance benefit to all of AGMA’s members, and is ready to get to work on day one.