Musician Zack Morgan plays keyboard for several bands in Austin, Texas. Since 2015, he has been a full-time musician after leaving his corporate job, humorously describing the transition as being pushed off a cliff. Morgan had balanced his roles as a tech worker and a funk keyboardist for years. He decided that moving to full-time music meant first regaining health insurance.

Austin promotes itself as “the Live Music Capital of the World.” Despite this reputation, the city often proves unaffordable for musicians contributing to its cultural value. To make ends meet, Morgan takes multiple gigs with different bands. He uses support from a local nonprofit, the Health Alliance for Austin Musicians (HAAM), to help pay for his health insurance. HAAM assists musicians by subsidizing their monthly insurance premiums through the Affordable Care Act (ACA) marketplace.

HAAM funds its $4 million program in partnership with Central Health, a public agency that offers healthcare resources to low-income residents in Travis County. Musicians often pay nothing toward monthly premiums. HAAM has provided consistent financial support for musicians throughout the years, including during the coronavirus pandemic. The program shows potential as a model for other cities to make key healthcare more affordable.

Texas has the highest uninsured rate among states, with 19% of individuals under 64 uninsured in 2024. HAAM initially spent over a decade connecting musicians with free and affordable healthcare options at clinics in Austin before the ACA marketplace began in 2014. Rachel Blair of HAAM noted that 85% of their members remained uninsured when traveling for gigs outside the state. The ACA’s arrival urged HAAM to prioritize complete insurance coverage for musicians.

Other U.S. cities with active live music scenes have similar nonprofits aiding musicians with medical care. Some of these organizations help with ACA enrollment but do not assist with premiums. HAAM realized that many members would struggle with coverage without direct premium aid. Blair emphasized that members earning roughly $30,000 annually cannot spend a third of their income on healthcare.

HAAM membership increased by 77% to over 3,300 people as the organization offered premium assistance, insuring over 90% of members. To subsidize member costs, HAAM partners with Central Health, which operates Travis County’s public hospital district, using tax dollars for safety-net healthcare. Central Health also manages Sendero Health Plans, offering marketplace insurance to county residents. HAAM members get qualified for Sendero’s silver-level plans, with premiums paid by Central Health after federal tax credits.

In 2017, HAAM helped establish a similar program in Denton, Texas. The Denton Music and Arts Collaborative connects with an independent insurance agent to find optimal health plans and offers members a $100 monthly subsidy. The collaborative supports Denton’s jazz and “weird art rock” culture and aims to retain artists as affordable living becomes challenging.

The annual HAAM Day Music Festival raises money for healthcare services and insurance premiums, featuring bands playing throughout Austin. This festival exemplifies how other sectors in Austin observe HAAM’s efforts. In 2025, the restaurant worker advocacy group Good Work Austin started a pilot program with Central Health to enroll food workers in Sendero plans and aid their premiums.

Kit Abney Spelce of Central Health emphasized partnering with specific advocacy groups to build community relationships and trust is key. Despite offering “free insurance,” signing people up remains a challenge.

Insurance premium costs regularly surge, but the 2026 plan year saw a notable 58% increase. Sendero costs rose 16%, while Congress retracted enhanced premium tax credits post-pandemic, reducing subsidies for ACA plans. HAAM met fundraising goals in 2026, yet hundreds of requests for assistance went unfulfilled.

Beyond musicians turned away in 2026, Austin’s poorest residents remain outside HAAM’s premium assistance scope. The ACA’s plans target low- and middle-income earners, while the poorest should benefit from expanded Medicaid. Texas didn’t extend Medicaid, leaving many poorest Texans uninsured.

Central Health offers the Medical Access Program, giving uninsured low-income individuals access to care providers. HAAM builds connections with primary care providers for uninsured musicians, though Blair notes expanded Medicaid would provide better benefits. Blair stressed HAAM’s solution lacks sustainability compared to Medicaid.

This report is a health-focused partnership by NPR with KUT and KFF Health News.