How have recent health insurance expansions affected coverage among artist occupations in the USA?

Most US workers receive their health insurance through employers due to its favorable tax treatment, improved bargaining power, and reduced adverse selection concerns. This institutional structure, however, favors large employers and full-time workers; thus, not all segments of the workforce enjoy the benefits of this system. Artists are especially disadvantaged relative to other sectors in the employment-based health insurance system as they tend to be self-employed workers and/or work on contractual bases. Theory suggests that the Affordable Care Act (ACA), by expanding options for health insurance to those without offers from employers, should represent an improvement, particularly for occupations that favor independent work, such as artists. We use large-scale survey data that identifies occupations and contains sufficient numbers of artists to study the impact of the ACA on the health insurance of these workers. We find that the 2010 Young Adult mandate of the ACA increases employment-related health insurance by 10.7 percentage points (ppts) (and any coverage by 6.6 ppts) for 21–25 year-old artists and that the Medicaid coverage rate of artists below the poverty level increases by 12.4 ppts (although its effects on any coverage are statistically imprecise) due to the state Medicaid expansion component of the ACA in 2014. Both these effects are significantly larger than for other workers. Our results thus indicate that recent health reforms have important and larger effects on artist occupations than other worker populations.