An Austin program that helps working musicians pay their health insurance premiums is drawing attention as a possible model for other cities, as marketplace costs climb for freelancers, contractors, and gig workers nationwide. The Health Alliance for Austin Musicians, known as HAAM, works with Central Health, Travis County’s public hospital district, to subsidize Affordable Care Act plans for local musicians, KFF Health News reported in a story produced with KUT and NPR.
The approach targets a structural gap. People who work for themselves have no employer plan, so they buy coverage on their own through the marketplace. This year, after Congress let enhanced federal premium tax credits expire, marketplace premium payments rose sharply, and many enrollees dropped coverage.
For a self-employed household, the timing is pressing. Insurers are seeking another round of increases for 2027, and open enrollment in states that use HealthCare.gov, including Texas, is expected to close earlier than in recent years.
Inside the Austin Model
HAAM members must enroll in a Silver-level plan from Sendero Health Plans, the nonprofit insurer operated by Central Health. For members with incomes between one and two times the federal poverty level, Central Health pays the remaining monthly premium after federal tax credits. Members above that range receive a smaller HAAM subsidy covering half of their premium balance. Many members pay nothing toward their monthly premium.
HAAM spent a decade connecting musicians with free and low-cost care before the ACA marketplace launched in 2014, but about 85% of members remained uninsured then, leaving them exposed when they traveled to gigs outside Austin.
HAAM’s membership has grown 77% to more than 3,300 people since premium assistance began, and more than 90% of members are now insured. The roughly $4 million program is funded with Central Health.
“When you think about the average HAAM member making about $30,000 a year, there’s no way that they would be able to spend a third of their income on healthcare,” said Rachel Blair, HAAM’s chief strategy officer.
The idea is spreading. In Denton, a nonprofit collaborative offers members a $100 monthly subsidy and help from an independent insurance agent. In Austin, Good Work Austin launched a small pilot with Central Health in 2025 to help restaurant workers enroll in Sendero plans and cover their premiums.
Kit Abney Spelce, vice president of operations for Central Health, said working with a trusted workforce group is essential because simply offering “free insurance for you” does not guarantee people will sign up.
Rising Costs Put the Program Under Strain
The 2026 plan year was especially expensive. Marketplace premiums increased 58% on average, according to KFF, and Sendero raised rates by an average of 16%. “Our premiums for our members went up 60% from one year to the next,” Blair said.
HAAM increased its fundraising but still had to turn away hundreds of qualified musicians in 2026. Central Health said it would keep paying monthly premiums for existing members.
Pressure continues into next year. Insurers in 16 states and the District of Columbia have asked regulators to approve a 14% median premium increase for 2027, according to a Peterson-KFF analysis reported by KFF Health News.
Freelancers in Non-Expansion States Face the Widest Gap
Texas had the highest uninsured rate among states in 2024, with 19% of residents 64 and younger uninsured, according to KFF data. Texas is also one of 10 states that have not expanded Medicaid under the Affordable Care Act.
That leaves a hole that premium assistance cannot fill. Marketplace subsidies generally start at 100% of the federal poverty level, about $15,000 for an individual. Workers who earn less in a non-expansion state often qualify for neither Medicaid nor marketplace help. Central Health’s Medical Access Program gives low-income, uninsured Travis County residents access to local providers, but Blair acknowledged it is not equivalent to Medicaid expansion.
Similar nonprofits in Seattle, New Orleans, and Nashville help musicians get medical care and navigate enrollment, but they have generally stopped short of paying premiums, KFF Health News reported.
Musicians, rideshare drivers, delivery workers, freelance designers, and restaurant staff face similar math: unpredictable income, no employer contribution, and a premium that can rival a car payment. Workers in their 50s and early 60s face the highest marketplace premiums because prices rise with age, and uninsured workers risk medical debt from a single emergency.
Deadlines and Options for Self-Employed Workers
For 2027 coverage, open enrollment in HealthCare.gov states is expected to run from Nov. 1 to Dec. 15, according to healthinsurance.org, and state-run exchanges must close by Dec. 31. That is about a month shorter than the recent Jan. 15 deadline in most states. Workers should confirm their state’s dates on HealthCare.gov or their state exchange.
Workers who miss the deadline generally cannot enroll until the next open enrollment period unless they have a qualifying life event, such as losing other coverage, moving, or having a baby. Free enrollment help from certified assisters is listed on HealthCare.gov.
Self-employed shoppers can take several steps now. Estimate net income carefully, since subsidies are based on projected earnings and big errors can mean repaying credits at tax time. Compare plans instead of auto-renewing. Ask local musicians’ groups, trade associations, and community health centers about premium help or sliding-scale care, and report income changes during the year.
Several uncertainties remain. Final 2027 rates have not been approved in every state, HAAM’s ability to add members depends on fundraising, and it is unclear whether other cities will fund similar programs.
The bottom line is that Austin shows one way to keep gig workers insured, but most freelancers nationwide have no such program. Checking eligibility early and meeting the shorter enrollment deadline are the most practical protections this fall.
Key Questions Answered
What is HAAM? The Health Alliance for Austin Musicians is a nonprofit that works with Central Health to help local musicians pay for marketplace health insurance premiums.
How does the subsidy work? For members with incomes between one and two times the federal poverty level, Central Health pays the remaining premium after federal tax credits. Higher-income members get a 50% HAAM subsidy.
Why are self-employed workers struggling with insurance costs? They lack employer plans, and marketplace premium payments rose sharply in 2026 after enhanced federal tax credits expired.
How much are 2027 premiums expected to rise? Insurers in 16 states and Washington, D.C., have requested a 14% median increase, according to a Peterson-KFF analysis.
When is open enrollment for 2027 coverage? HealthCare.gov states that it is expected to run from Nov. 1 to Dec. 15, 2026. State-run exchanges must close by Dec. 31.
Why is Texas’s coverage gap so large? Texas has the highest uninsured rate among states and has not expanded Medicaid, leaving many low-income adults without affordable options.
What can gig workers do now? Estimate income carefully, compare plans instead of auto-renewing, and ask local groups or community health centers about premium help.
