"I really hope it stays in place," says jeremy messersmith about the Affordable Care Act. "If that just means rebranding it as Trumpcare, then sure, why not?"

When Donald Trump is inaugurated as the 45th president of the United States, the Republican party will control both the legislative and executive branches of the national government, and party leaders have said that one of their top priorities is repealing the Affordable Care Act (ACA) — President Barack Obama's signature domestic policy achievement. Last week, they took the first step toward repeal.

Trump has said the act will be replaced with "a plan that's going to be great for people," but Republican leaders haven't provided many details regarding how that might be accomplished. Bassist John Munson says he'd welcome improvements, if they actually materialize.

"If I felt confident that some kind of a plan was going to be put in place that was really going to be useful to people and that's something the Republicans can do, then more power to them," says Munson, best-known as a member of Semisonic and the New Standards.

Repealing all or part of the ACA would affect all Americans in one way or another, but musicians are particularly likely to be affected because they're typically self-employed. "Many musicians, rather than having one full-time employer, balance multiple gigs and income streams — tour income, occasional royalty checks," explains Kevin Erickson of the Future of Music Coalition. Prior to the ACA, says Erickson, musicians were nearly three times as likely as non-musicians to lack health insurance.

"Without access to employer-based coverage," Erickson continues, musicians "often find themselves having to purchase coverage on the open market, and before the ACA, those individual plans were often inaccessible for a variety of reasons. Because of the subsidies and the Medicaid expansion, individual plans are accessible to a lot more people, and because of the provisions around pre-existing conditions, musicians that found themselves unable to be insured — that's been resolved as well, and it's something that impacts a lot of musicians."

Since the ACA went into effect, says Erickson, "we've seen countless musicians getting insurance for the first time in their adult lives." Many Minnesota musicians are among those who have been able to obtain medical care under the act, and members of the music community — both locally and nationally — are expressing trepidation about what the status of their health insurance might be if the act is in fact repealed.

"We're hearing a lot of panic and anxiety" among local musicians, says Ellen Stanley of the Minnesota Music Coalition — and she notes that this is despite the fact that Minnesota had some relatively good options (compared to other states) before the ACA was enacted. If the ACA is repealed in full or in part, she says, it's unclear what musicians' insurance options might be.

Singer-songwriter messersmith (who recently requested that his name be written without capitalization) says he's concerned about what repeal might entail. "It was nearly impossible for me to get coverage, due to a pre-existing condition, prior to the ACA," he says. "If they get rid of the pre-existing conditions part of the ACA, then I will either not be able to find a plan that will take me, or I will have to pay large amounts of money for a plan that won't cover much."

Repeal "would affect a ton of people in the local scene," says messersmith. That would include "everybody I know who works at a job where they're kept just under the amount of hours that it takes to be a full-time worker, so their employer doesn't provide them health benefits — any of the local musicians I know who work as waitstaff or bartenders, or anything like that. I imagine it would affect nearly everyone."

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Erik Hess, a music photographer who was previously denied coverage due to a pre-existing condition, puts his feelings about the planned repeal bluntly. "Thanks, fellow citizens, for reminding me that folks like me are too expensive to keep alive," he wrote sarcastically in a post on Facebook. "I guess it's unreasonable for me to think my CVID [common variable immune deficiency, a chronic illness thought to be due to gene mutations] is anyone else's problem. It's high time for me to show some personal responsibility for my illness and work hard to pay for my $10,000-a-month IVIG treatments out of pocket like a good, productive citizen.

"It's funny, really, after all that talk of 'death panels' all those years ago," Hess continued, "that Congress itself is actively condemning a large chunk of our chronically ill population to an early death with massive debt as the only alternative. With millions of Americans cheering them on. With no backup plan for any of us."

Munson points out that when health insurance is unaffordable, many musicians — particularly young and healthy ones — are tempted to go entirely without insurance, putting themselves at risk of financial ruin if a health crisis occurs. "If you don't have some kind of coverage when those bills come due, it truly will wipe you out. It'll just wipe you out."

Claire de Lune (tiny deaths, The Chalice) points out that the life of a musician enacts a toll. "It's hard on your mental health, it's hard on your physical health. Access to health care is so important."

De Lune thinks the ACA "has been hugely successful. I personally know a lot of people in the music world who've gotten insured because of the Affordable Care Act, and people who've gotten access to things like mental health care and reproductive health care. It's awesome that [the ACA] has given people like me have the ability to see a therapist for a very low copay, but there are also people I know who got diagnosed with cancer — and if these people lose their health care, it is life or death."

Musicians' advocates emphasize that as long as coverage is available, artists should sign up. "If you're still uninsured," says Erickson, "you have until Jan. 31 to sign up through healthcare.gov, and we're really encouraging people to do that — both because we know that it's better to be covered than not to be covered, but because the more people who sign up now, the more difficult it's going to be to kick them off down the road."

The Affordable Care Act (ACA) — also widely referred to as "Obamacare" due to its association with the president who advocated the legislation — is a complex set of policies that are now deeply integrated into the country's health care system. Repeal would be complex, and it remains unclear exactly what provisions might be changed and when.

"The ACA is far from perfect," wrote Nikki Hunt, of Springboard for the Arts, in an e-mail. "Health insurance still doesn’t guarantee affordable healthcare and it's way too complicated to get and keep insured, especially with the way the market offerings turn over every year. But, a big reason the ACA couldn't get better is because every critique of the system was turned into a cry to tear the whole thing down.

"The ACA is essentially a conservative mandate for the health insurance marketplace with some additional social safety nets," continued Hunt. "It’s a good thing that artists and musicians, who were often under- or uninsured because of their self-employment status or pre-existing conditions, can now get coverage. I wonder, as Republicans take their turn at this, will they become more open to compromise, and working together across aisles, down the road?"

Previous to the ACA being enacted, one Minnesota musician actually had to leave the country because he couldn't afford American health care: Kevin Steinman now lives in Norway, and says he receives excellent health care at far less cost. "That's a singer-songwriter our ecosystem could not support anymore," says messersmith, "and that is f---ing sad."

The ACA also helped local drummer Alex Young, who's played with artists including Rogue Valley and the Honeydogs. "Drumming has been my only source of income for a long time now," he wrote in an e-mail. "I remember back when I first quit my other job, my BlueCross BlueShield premiums were reaching about $250/month. Thankfully, ACA came along and those premiums went down considerably, making it much easier to sustain living as a musician."

Munson also obtains health insurance (with the other members of the New Standards) through an ACA-enabled marketplace, but his experience hasn't been as positive: like many Minnesotans, he's recently seen his premiums rise. "We watched as the deductible went up and as the premiums skyrocketed." The ACA, he says, "is something that's been really great for a lot of people, but it hasn't been particularly great for me and my family."

Despite the ACA's shortcomings, Erickson says it's been crucially important for musicians — "and we're not just talking about little indie bands schlepping from gig to gig in the tour van. It's a problem that's reaching all the way up to people who are headlining summer festivals who have been going without insurance for a long time.

"That was the baseline before the Affordable Care Act," continues Erickson, "and we just can't go back to that. We'll miss out on so many people's voices. There are so many songs we won't hear if we go back to a situation where musicians are expected to endure that."

Munson says he'd like to see America try a single-payer system, with guaranteed coverage for all. "Making health care this bone that both parties are trying to get away from each other, either [to] claim credit for it or to bury in the backyard, is not good. As a source of partisan bickering, I really hate it. Health care should be a right."