For Richer, For Poorer, In Sickness, and For Health Insurance

by Brigette Courtot, Policy Analyst
National Women’s Law Center

This post is part of a weekly series on Women and Health Reform.

A few weeks ago, I took part in my best friend’s wedding. She was a beautiful bride, and everything went according to plan.  Well, almost everything. 

Several months ago, the bride-to-be left me a voicemail. She was clearly upset. Hundreds of possibilities occurred to me - a major fight over the guest list? Bridesmaid dresses discontinued? I never would have guessed that it had something to do with health coverage. What does health insurance have to do with a wedding?

Here’s the story: my best friend had been working full-time as a teacher’s aide and was covered under her school system’s health plan. But she is studying to be a teacher, and needed to leave the job to fulfill her student teaching requirement. She couldn’t afford her university health plan. She shopped around in the individual insurance market, but the policies were too expensive, or they didn’t cover treatments for the form of arthritis that she was diagnosed with a couple of years ago. She even considered going without any insurance at all, but knew she couldn’t pay out-of-pocket for her arthritis medications and didn’t want to live in constant fear of a catastrophic health event.

So she turned to a final option, one she hated to even consider. Her fiancée worked for a large company with comprehensive health benefits - when they married she would get spousal coverage under his plan. They would have an early civil ceremony with a justice of the peace, strictly for the purpose of sharing benefits. She explained, “Maybe I’m making too much of this, but it feels wrong to have a secret ceremony months before our real wedding just so that I can get health coverage. I don't even want to tell anyone in our families about it.  It will make our true wedding seem, well, less significant.”

It feels wrong to me too, but not because her actual wedding would be any less meaningful. It feels wrong because health insurance shouldn't be dictating our major life decisions, like whether, who or when to marry.  Fortunately, my best friend is with someone who loves and treats her well, someone she wanted to be with even before health benefits came into play. But what if that weren’t the case?  What about those women who might enter into or stay in a marriage that isn’t right for them because it is the only way they can get health coverage? (And as I’ve pointed out before, what about the millions of people in committed domestic partnerships, who aren’t likely to even have the option of getting coverage for their loved one?)

Earlier this year, the Kaiser Family Foundation conducted a survey in which 7 percent of respondents reported that someone in their household decided to get married in the past year mainly to have access to health care benefits. (Notably, the survey didn’t even explore the issue of people staying in marriages to keep their benefits.) Due to some uncertainty about how the question was asked, Kaiser cautioned against interpreting the statistic literally, but I’m alarmed nonetheless. Any percentage of Americans marrying primarily for health benefits is unacceptable. We need progressive health reform  so that all women have access to comprehensive affordable health coverage, and can make life decisions without worrying about their health insurance.

Comments

[Brigette]

Nicky, thanks so much for alerting us to the work that your organization is doing on this issue. I look forward to learning more about your efforts related to health reform in the fall and will keep an eye out for the expanded site!

[Nicky Grist]

Thanks for adding to the growing recognition that marriage is the on/off switch for access to health care in America. The Alternatives to Marriage Project is studying the effects of marital status on not only employer-based health insurance, but also health care decision-making and the ability to leave work to care for loved ones. www.unmarried.org/universal-health-care.html is a bare-bones site now, but it will be greatly expanded by September. We look forward to partnering with NWLC and other organizations to remind health care policy makers that reform isn't universal unless it's marriage-neutral.