I’ve got an Op Ed in yesterday’s Philadelphia Inquirer. Here’s the complete text:

America’s artists: Canaries in the health-care mine

America’s two million artists understand what it means to be a worker in the 21st century, independent, untethered, and mostly expected to fend for themselves.

So for them, the number of uninsured Americans isn’t an abstract statistic. It’s their life. They are the canaries in the coal mine when it comes to health-care reform.

Independent artists have always had unconventional employment relationships, with high levels of self-employment, episodic work patterns, and roller-coaster incomes. With no access to employer-based coverage, most buy health insurance on the individual market or through trade associations. Outside the shelter of a large employment-based group, they face higher rates, medical underwriting that can deny coverage because of existing conditions, and opaque bureaucracies that strive to avoid paying claims.

At Fractured Atlas, we’ve been working to provide artists with affordable health insurance since 2001. As a nonprofit organization, we help our members understand their coverage options, guide them through the enrollment process, and advocate on their behalf. Navigating the system, with a hodgepodge of state-level regulations and an emphasis on employee groups, makes it unnecessarily difficult to serve our community. Despite our best efforts, thousands of working artists remain uninsured.

President Obama’s reform package offers hope. The foundation of the plan - guaranteed coverage for existing conditions - is an unqualified win. Individual underwriting is rarely an issue for employee-group plans, but we see denials of coverage every day. When a 23-year-old vegetarian dancer can be turned down for coverage because of her eczema, I shudder to contemplate how much wasteful spending goes toward cherry-picking the healthiest customers. We have to put such nonsense behind us.

Artists also stand to benefit from an “individual mandate,” which would require them to buy health insurance or face stiff penalties. Forcing the “young invincibles” to participate in the system will stabilize the risk pool and bring down rates for everyone. It will also reduce unreimbursed emergency care, which increases costs throughout the system. The more libertarian-minded will resent being required to buy an insurance policy, but the benefits justify some amount of paternalism.

There aren’t enough details yet about a so-called public option to know whether this would help our efforts to insure the creative community. An effective public plan must provide stiff competition for private insurers in today’s highly monopolistic markets. When one carrier controls 85 percent of a market, it has little incentive to take risks on a group like ours.

However, any public plan should play by the same rules - risk reserve requirements, coverage mandates, and the like - as its private counterparts. Otherwise, private insurers will be driven out of business and there will be fewer choices and less innovation than exists now.

In addition, comprehensive health reform would create federally regulated, association-based plans. Individuals must have the right to band together via a competent intermediary that can provide education, advocacy, and support. Currently, groups like Fractured Atlas must wrestle with 50 state insurance departments, each with its own regulations and approval processes. We end up with different health plans in different states for our community of 100,000 artists. This reduces bargaining power and limits economies of scale. These problems would disappear if we could provide one plan under a single set of federal rules.

It is imperative that our nation’s health insurance system accommodate the growing mobile, independent workforce. Reform that improves access and affordability for working artists could save the canary, and maybe the rest of us, too.