In Sickness and in Health Insurance

Today we’re talking about the relationship between taking your vows and taking your medicine. In 2020, more than a quarter of folks who got married said they took the plunge because one of the partners involved needed health insurance, and it seems like some couples are staying together for the insurance as well. In this episode we’ll break down how our healthcare system is set up to get us paired up and how Medicare for All could save you a trip down the aisle.   

Show Notes

Trigger Warning: On today’s episode, we’re also going to be discussing some of the dark side of marriage, including domestic violence, which we know is a topic that can raise some traumatic feelings in survivors and might not be appropriate for any kids you have in the room. Of course, we also want to remind you that if you or someone you love needs help with a DV situation, you can call the National Domestic Violence Hotline at 800-799-SAFE (800-799-7233) to find resources in your area.

People Don’t Really Get Married for the Health Insurance Do They?

  • A survey by found that 26% of American couples married in 2020 said they got hitched because their partner needed the insurance.
  • This number spiked in 2020 because of the COVID-19 pandemic.
    • 7.7 million people lost their jobs and had to find an alternative source of health insurance. 
    • We can’t assume people ONLY got married for the insurance, but a life-altering event like COVID and the associated economic turmoil probably sped up their timelines to the altar 
  • In that same survey, 28% of respondents making less than $50,000 a year reported they did so for the insurance. Overall income brackets are a factor here. 
  • Sometimes people do this not because they lost a job, but because their employer’s insurance changed/decided to skimp on coverage (check out this reddit story and subsequent comments:

How does getting married impact access to health insurance?

Marriage changes how you qualify for health insurance subsidies under the Affordable Care Act. Once you’re married, your combined income determines if you are eligible for help.

As a couple, you can earn a joint income of up to 400% of the federal poverty level, or $69,680, to qualify for premium subsidies. If you earn more than $69,680, you might qualify for an extended subsidy that limits your insurance cost to no more than 8.5% of your household income. The extended subsidy is in effect through 2025.

Family deductibles (and out-of-pocket costs) tend to be about twice as much as those for individuals

The Kaiser Family Foundation found that on average, health spending by families with large-employer health plans has increased two times faster than workers’ wages over the past decade. More costs have been pushed onto employees in the form of deductibles

Interestingly, in that same survey mentioned before, 69% of the couples married in 2020 for health insurance said they wished they could have stayed on separate plans! Likely because of costs.

The stories of people getting married for health insurance (and love) are on the rise. Some examples: 

So your employer has control over your family’s health insurance. What could go wrong?

According to the Medical Expenditure Panel Survey (by AHRQ) Insurance Component survey, in 2021:

  • 98.1% of private-sector employees worked for an employer that offers SOME dependent coverage
  • Less than 50% of Americans worked for employers that cover dometic partners, including same-sex domestic partners. [Only 49.3% of employees worked for employers that cover SAME-SEX domestic partners through their family plans – similar to the percentage covered by opposite-sex domestic partners/] 
  • 92% of full-time employees were eligible for health insurance at workplaces where insurance is offered (71.3% of full-time employees were enrolled in those health plans – 65.6% of all full-time employees enrolled, including at workplaces that don’t offer) – pp. 75, 77
  • 24.7% of part-time employees are eligible for health insurance at workplaces where insurance is offered (43.1% of part-time eligible employees were enrolled in those health plans – 10.6% of part-timers enrolled at all workplaces that offer insurance, but where they might not be eligible) – pp. 85, 87, 89
  • Average employee contribution for single coverage: $1,643 (22.3% of the total premium) – pp. 92, 107;  average employee contribution for family coverage: $6,174 (28.9%) – pp. 127, 135. For SMALL businesses: $6,967 (34.1%).

Depending on a partner for health insurance creates an unequal power dynamic in relationships. Abusive partners can take advantage of this source of power,

We met a healthcare advocate who stayed in an abusive marriage for many years because, at least in part, she relied on his family health plan for coverage. Gillian tried to look into the topic, but because domestic violence is perceived as a “women’s issue” there hasn’t been much research.

In 2007, a study in Boston showed that nearly 1 in 5 women surveyed who had experienced intimate partner violence (IPV) in the previous year had also experienced their partner interfering with their access to healthcare – preventing them from going to doctors’ appointments and interfering with treatments, for example.

We know that women in abusive relationships have worse health outcomes (including avoidable deaths) – both as the result of physical violence and the psychological impact of living with constant violence.

Also, as that same study points out, “Women experiencing recent IPV work fewer hours, at lower wages, and have unstable work patterns (defined as more time unemployed). In one qualitative study, over 90% of battered women interviewed had resigned or been terminated from a job in the last two years because of domestic violence. Women reported that their partners used several tactics to prevent them from going to work, including physically restraining them or not making a shared car available.”

Combine that with an employer-based healthcare system and you’ve got a recipe for keeping women dependent on their abusers.

The ACA made this situation a little bit better. In 2013 The Family Violence Prevention and Services Programs offered a guide to the ACA for folks who provide services to domestic violence survivors, touting the improvements in the ACA that would impact domestic violence survivors: lower cost of services, Medicaid expansion (where available), easier access through the website, a special enrollment period for domestic violence survivors in the process of leaving abusive relationships, and a hardship credit that exempts people in domestic violence situations from the penalty for not having insurance.

Medicare for All, of course, would be the ultimate liberation for people who are dependent on an abusive spouse, or just stuck in an unhappy marriage. Every American would have insurance, cradle to grave, regardless of income or employment, no eligibility hoops, no deductibles.

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