Shannen Doherty, the actress best known for her roles in Beverly Hills, 90210 and Charmed has died after a long battle with cancer, at the age of 53. In a 2015 statement to People magazine, the actress revealed her breast cancer diagnosis, stating that she was “undergoing treatment” and that she was suing a firm and its former business manager for causing her to lose her health insurance due to a failure to pay the insurance premiums. According to reports, in a lawsuit Doherty shared that she hired a firm for tax, accounting, and investment services, among other things, and that part of their role was to make her health insurance premium payments to the Screen Actors Guild; Doherty claimed that their failure to make the premium payments in 2014 caused her health insurance to lapse until the re-enrollment period in 2015. When Doherty went in for a checkup in March of 2015, the cancer was discovered, at which time it had spread. In the lawsuit, Doherty indicated that if she had insurance, she would have been able to get the checkup sooner—the cancer would have been discovered, and she could have avoided chemotherapy and a mastectomy.
Under the IRS, actors are often classified as independent contractors, which comes with its own set of challenges. Although it is unclear what Doherty’s situation was, for many independent contractors, obtaining health insurance can be difficult. Trying to get health insurance as an independent contractor can be a costly and convoluted process. A 2020 Actors’ Equity Association survey indicated that “more than 80% of nonunion actors and stage managers in California have been misclassified as independent contractors.” A 2021 research study revealed that self-employment (which is what independent contractors are considered to be) was associated with a higher likelihood of being uninsured.
Doherty’s tragic situation invites a larger conversation about healthcare access and equity in the United States. According to the Center on Budget and Policy Priorities, the Affordable Care Act (ACA), also known as “Obamacare,” was signed into law in 2010 and revolutionized healthcare access in two distinct ways: “creating health insurance marketplaces with federal financial assistance that reduces premiums and deductibles and by allowing states to expand Medicaid to adults with household incomes up to 138 percent of the federal poverty level.” The ACA helped reduce the number of uninsured Americans and expanded healthcare access to those most in need. It also helped close gaps in coverage for different populations, including those with pre-existing health conditions, lower-income individuals, part-time workers, and those from historically excluded and marginalized populations.
Despite strides made through the ACA, healthcare access and equity are still persistent issues, especially within marginalized communities. Research from the Henry J. Kaiser Family Foundation (KFF) examining 2010-2022 data indicated that in 2022, non-elderly American Indian and Alaska Natives (AIAN) and Hispanic people had the greatest uninsured rates (19.1% and 18% respectively). When compared with their white counterparts, Native Hawaiian and Other Pacific Islanders (NHOPI) and Black people also had higher uninsured rates at 12.7% and 10%, respectively. The Commonwealth Fund reported that between 2013 and 2021, “states that expanded Medicaid eligibility had higher rates of insurance coverage and health care access, with smaller disparities between racial/ethnic groups and larger improvements, than states that didn’t expand Medicaid.” It’s important to note that if a Republican president is elected, Project 2025, the far-right policy proposal document, seeks to upend Medicaid as we know it by introducing limits on the amount of time that a person can receive Medicaid.
When peeling back the layers to examine these racial and ethnic differences in more detail, the Brookings Institute noted in 2020 that the refusal of several states to expand Medicaid could be one contributing factor. One 2017 research study found that some underrepresented racial groups were more likely to experience insurance loss than their white counterparts. The study indicated that for Black and Hispanic populations, specific trigger events were more likely, as well as “socioeconomic characteristics” that were linked to more insurance loss and slower insurance gain. The study also noted that in the U.S., health insurance access was associated with employment and marriage and that Black and Hispanic populations were “disadvantaged in both areas.”
Equity in and access to healthcare is fundamental, but bias is omnipresent. Age bias, for example, is a pervasive issue in breast cancer treatment. Research also indicates that racial bias is a prevalent issue—because the current guidelines in breast cancer screenings are based on white populations, this can lead to a delayed diagnosis for women from non-white communities. Our health is one of our greatest assets and healthcare should be a basic human right, no matter what state or country you live in. As a society, we must ensure that healthcare is available, affordable and accessible to all citizens. After all, how can a country call itself great if so many of its citizens, especially those most marginalized and vulnerable, don’t have access to healthcare?
