You have all picked up on the biggest problem with instituting healthcare for performers and others in the industry. That is, performers come and go. So here's a posible solution. Require that in order to perform in an adult production that performers show proof that they have health care coverage. If they do not have a policy, they will be required to join in a plan underwritter by studios, agents and Aim to lower costs and administered by Aim.
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"This thing is ready to do damage!"