Data show marital status impact on health coverage but not health
My inner geek is having a great week (at the expense of my less robust inner fundraiser – please help me restore psychic harmony by making an easy, secure, tax-deductible donation to support this work)!
New data on the impact of Massachusetts’ 2006 health reform law demonstrates the link between women’s marital status and health coverage:
… roughly 60,000 women aged 18 to 64 were uninsured in fall 2009. Moreover, one in every five women reported problems obtaining care or paying for the care they needed. … The women who were uninsured … were disproportionately young (ages 18 to 25), Hispanic, and single.
My quick crunching of the new data on MA women produced some eye-opening numbers:
- for every 100 women who are living with their unmarried partners and who have health insurance, there are 150 uninsured cohabiting women;
- for every 100 ever-single women with health insurance, there are 223 uninsured ever-single women;
- for every 100 divorced, separated, or widowed women who have all their health care needs taken care of, there are 135 divorced, separated, or widowed women with some unmet need for health care;
- for every 100 cohabiting women who had no trouble finding a doctor, there are 137 cohabiting women who are having difficulty finding a doctor (or finding one who accepts their insurance or new patients). Thanks, Rachel, for checking my math!
This report reaffirms findings about both men and women which were released by the same research team late last year. Of course, coverage and access differentials correlate to numerous variables, but the difference between married and unmarried MA residents’ health care is so big that it keeps showing up in the reports’ opening lines.
I was bothered by the 2009 report’s implication that young single men preferred to be uninsured, so I checked in with Tom, an AtMP member who is an MD-MPH in Boston. He wisely said “I suspect that “never married’ is the least of the reasons that young men choose not to be insured. Un/underemployment, poverty, and feeling invulnerable are much more important reasons. “Never Married” most likely popped out of the data analysis software (which) will correlate everything unless you tell it not to.”
MA’s health reform legislation was an important model for national health reform, so everyone is watching MA’s results because they may predict what we’ll see nationwide. So far, it looks like the failure to create a single-payer system or to help everyone get equal access to coverage regardless of martial status will recreate the inequality we’ve been living with for years: unmarried people are more likely to lack access to affordable health care.
That stinks, not only because it’s unjust but also because it could fuel the next perennial wildfire of sloppy media reports claiming that ‘marriage makes you healthier.’ Luckily, a new study on people in the UK offers a big bucket of water to throw on that fire. In sum, it “finds that the effect of cohabitation on health is not statistically different from the effect of marriage….”
This study’s American authors tried to take into account the way peoples’ health changes over time, and to
disentangl[e] the selection effect (healthy people make better marriage partners, ceteris paribus) versus the so-called protective effect of marriage (married people are healthier because they have a spouse who can monitor their health behaviors, care for them when they are ill, and discourage them from engaging in risky behaviors, such as smoking and drinking). It is the latter effect that is of interest to economists as it represents the causal effect of marriage on health. …
The striking result is that once we control for both selection and health dynamics cohabitation and divorce are insignificantly different in their effect on health than marriage for all sub-samples. Never married is only weakly significantly worse for health and only for all women and women under age 40. … our results suggest that both males and females may gain comparable protective effects from cohabitation and the negative health effects of divorce found by some researchers may be overstated. …
Of course, don’t forget that they studied people who all enjoy equal access to the UK’s national health system – no Brit ever gets married to get health insurance! Interestingly, they found that income still affects health despite the national health system, partly because lower income people are exposed to more health hazards (low-quality food or housing, for example).
| for every 100 divorced, separated, or widowed women who have all their health care needs taken care of, there are | 135 | divorced, separated, or widowed women with some unmet need for health care. | |||||
