The facts behind creative work.

Most artists already had health insurance, so the work ahead is turning coverage into care.

The picture of the uninsured artist comes from an earlier decade. In 2013, a survey by the Future of Music Coalition and the Actors Fund found that 53% of musicians had no health insurance. The recent numbers look very different. NORC at the University of Chicago surveyed 2,618 artists in late 2024 and found that 84% had access to health insurance. The 2025 MusiCares Wellness in Music survey, with about 3,200 music workers, put the figure at 85%.

Coverage comes from many places. Among artists with access to health insurance in the NORC survey, coverage came through a main job (32%), a spouse or partner’s job (25%), Medicare (27%), Medicaid (21%), buying it directly (18%) and the marketplace (15%). MusiCares reports that nearly half of its respondents are covered through federal programs or the Affordable Care Act.

Having a card is not the same as getting care. In the same NORC survey, 29% of artists could not get medical care they needed, and 17% hold medical debt. Three things stand between the coverage and the care, and each has its own post here: income that changes from month to month, deductibles too high to use the plan, and a business of one that has no group plan to join.

That is good news for anyone trying to help. The coverage is largely there. The work is making it usable.

Health coverage is priced on a yearly income estimate, and 59% of self-employed people see their income change from month to month.

A paycheck arrives on a schedule. A creative worker’s income arrives when the tour pays, the royalty statement lands or the session invoice clears. The Federal Reserve’s 2024 survey of household finances found that 59% of self-employed people had income that varied from month to month, against 28% of people who work for someone else. Among gig workers, 49% said they wish the pay was more consistent.

Marketplace health coverage is built for the steady case. The premium tax credit that lowers the monthly bill is based on an estimate of the year’s income, made in advance, and settled on the tax return. When the year turns out different from the estimate, the difference comes due at filing. The IRS reported that for tax year 2014, 51% of people who filed to settle the credit had received more in advance than they qualified for, and owed back about $860 on average. About 8% had received exactly the right amount.

The Federal Reserve also found that 11% of adults struggled to pay their bills in the prior 12 months because their income varied.

Steady planning turns the estimate into a number someone can stand behind: tracking income as it arrives, reporting changes to the marketplace during the year, and setting money aside for the reconciliation.

Coverage becomes care when people can afford to use it, and half of year-round marketplace enrollees are underinsured.

The Commonwealth Fund counts a person as underinsured when out-of-pocket costs reach 10% of income, or 5% for lower incomes, or when the deductible alone reaches 5% of income. By that measure, 23% of working-age adults were insured all year but underinsured in 2024.

The share is far higher on the marketplace. Half of people enrolled in a marketplace plan all year are underinsured, against 29% of people on employer plans.

The plans themselves show why. KFF reports that the average 2026 bronze plan deductible is $7,476, and the out-of-pocket maximum is $10,600 for one person. In KFF’s 2025 survey of marketplace enrollees, 61% said deductibles and out-of-pocket costs are hard to afford.

A bronze plan keeps the monthly premium down and moves the cost to the moment of care. Choosing the right plan for the year ahead, and having the cash in place to use it, is what turns a policy into a doctor’s visit.

A group health plan needs employees, and under federal benefits law a business of one has none.

A creative worker who forms a company to run their business might expect that company to offer a health plan, the way an employer does. Federal benefits law draws the line differently.

Under the Department of Labor’s rule, an individual and their spouse are not employees of a business wholly owned by them. A plan that covers only the owner has no employee participants, which places it outside the federal law that governs employee benefit plans.

The newer options follow the same line. A qualified small employer health reimbursement arrangement lets a business reimburse health costs, and it is built around employees. PeopleKeep, a benefits provider, says sole proprietors and partners can’t participate unless a spouse is a W-2 employee of the business, and S corporation shareholders with more than 2% of shares can’t participate.

So the business of one sits between two systems. The owner runs a real business, often with a company and a tax return of its own, and still shops for health coverage as an individual.

That gap is a design question, and design questions have answers.

Nashville’s creative workers bring in $3.56 billion a year, and the opportunity is in managing and organizing it.

The idea that musicians are broke does not hold up against the Census. In Greater Nashville in 2023, creative workers who operate on their own earned $1.87 billion in revenue, and creative workers with an employer were paid $1.69 billion in payroll. Together that is $3.56 billion a year.

The money is there. A creative worker who operates on their own runs the back office of a business of one: payroll, tax administration and filing, group and bespoke healthcare, business capital and business intelligence. The business and the household can run through one person’s hands.

That load shows up in the research. The Federal Reserve found that monthly income changes for 59% of self-employed people. MusiCares found that 40% of music workers attribute their anxiety to finances, and 32% their depression.

Organizing the money is where the gains are: separating the business from the household, setting aside taxes as income arrives, and planning the year on real numbers.

65 of every 100 Nashville creative workers operate on their own, more than three times the national share.

Picture Nashville’s music business and you might picture the labels, the studios and the big venues. They employ thousands. Most creative workers, though, work for themselves.

Census figures for 2023 count 41,425 creative workers in Greater Nashville. 26,948 of them operate on their own. 14,477 have an employer, such as a venue, a label, a studio or a theater company. That is 65 of every 100 creative workers operating on their own. Across the entire country, in every industry, the figure is 18 of every 100.

Music Health Alliance, which works with Nashville’s music community, reports that 75% of Nashville’s music ecosystem is self-employed or working for a small business.

In the Foundation’s view, each of those 26,948 runs a business and a household at once. That is the population the Foundation is built to serve, one person at a time.

Insurance is the start: music workers with coverage still weigh the deductible before they use it.

MusiCares sees this from the front line. In a 2025 op-ed, it reported that most of its clients have health insurance but may not use it because they cannot afford the deductible, the provider does not take their insurance, or the provider is out of network.

The survey data points the same way. 85% of music workers in the 2025 MusiCares survey have health insurance, and 78% earn under $100,000 a year. KFF found that 61% of marketplace enrollees find their deductibles and out-of-pocket costs hard to afford.

Getting people insured was the right first goal, and it has largely been met. The next goal is making sure the insurance gets used: plans matched to how each person earns, and the cash in place when care is needed.

The self-employed health insurance deduction lowers income tax, and the 15.3% self-employment tax stays the same.

Self-employed people can deduct what they pay for health insurance. It is a real benefit, and it is narrower than it sounds.

The deduction lowers income tax. It does not lower self-employment tax, the 15.3% that pays for Social Security and Medicare for people who work for themselves.

There are limits too. The deduction can’t be larger than the profit from the business, so a slow year shrinks it. It can’t be taken for any month the person was eligible for a subsidized employer plan, their own, a spouse’s or a dependent’s, even if they did not join. For owners of more than 2% of an S corporation, the premiums are reported as wages first.

All of this is in the IRS instructions for Form 7206. It rewards people who plan the year ahead: who know which months they were eligible for which plan, and whose books show the profit the deduction depends on.

Music workers name money as a source of anxiety and depression, and MusiCares calls for a financial safety net.

MusiCares has run its Wellness in Music survey every year since 2020. The fifth edition, published on September 30, 2025, drew nearly 3,200 respondents from every music profession and genre in the United States and measured more than 100 indicators of financial, physical and mental well-being.

Money runs through the mental health findings. 40% of music workers attribute their anxiety to their finances, and 32% attribute their depression to their finances. 78% earn under $100,000 a year, and most say music work alone does not cover their expenses.

MusiCares provided more than $3 million for basic needs such as rent and utilities in the past year. Among its recommendations, MusiCares calls for building a financial safety net that pairs direct assistance with financial management advice and education.