Staying Married for the Health Insurance

A study of more than 17,000 married people found that those dependent on a spouse for health insurance were less likely to divorce

Here at Unmarried America, we believe that no one should have to marry to get access to something so fundamental as health insurance. And yet, there is evidence that some people do just that.

What about staying married? Does access to health insurance factor into that decision? A study of more than 17,000 married people suggests that it does, especially for women.

Tracking the Divorces and Health Insurance Access of 17,000 Married People for 4 Years

From 2003 through 2007, a nationally representative sample of 17,388 married people were surveyed repeatedly. They were participants in the Survey of Income Program participation (SIPP), which tracks employment and health insurance status, among many other variables. Some data were collected as often as every month, and other information, such as marital status, was assessed every four months.

Sociologist Heeju Sohn of the University of Pennsylvania analyzed those data to answer three questions:

1. Do married people who are insured on their spouse’s health insurance plan have lower rates of divorce?
2. Do married people insured on their spouse’s plan have especially lower rates of divorce if they are not employed or have no option to get health insurance from their own employer?
3. Are women especially likely to be deterred from divorcing if they are dependent on their spouse for health insurance?

The couples in the study did not include any same-sex couples. The Supreme Court decision legalizing same-sex marriage nationwide, Obergefell v. Hodges, did not happen until 2015, after the data for this study had been collected.

Professor Sohn only analyzed data through 2007, which was before the Affordable Care Act was passed in 2010. Even now, though, most people with health insurance are covered by their employer rather than by Obamacare or private plans. According to the Census Bureau, the percentage of people with employer-provided health insurance in 2019 was 55.4. Figures from the Congressional Budget Office for adults under 65 indicate that 58 percent had employer-based coverage, 31 percent had other coverage, and 11 percent were uninsured.

Married People Dependent on a Spouse for Health Insurance Were Less Likely to Divorce

Sohn found that at any point in time, married people who were insured on their spouse’s plan were much less likely to divorce or separate than those who were insured under their own policies. In fact, being dependent on a spouse for health insurance lowered the likelihood of divorce by nearly 70 percent.

Some married people who are covered under a spouse’s plan are employed and could be covered under their own employment-based plan. They chose their spouse’s because it was better. They don’t need to stay married for the health insurance. They have another alternative, even if it is not as good.

Other married people who are covered under a spouse’s plan, though, are not employed and have no employer-based health insurance plan to fall back on if they were to divorce. Those people are especially unlikely to divorce.

Access to their own employer-based health insurance mattered more to the married women than the married men. The women who were covered under their husband’s plan and had no employer-based option of their own were especially unlikely to divorce. Having no employer-based alternative of their own lowered men’s likelihood of divorcing, too, but not as much as it lowered women’s.

More Income and Education Seems to Keep Couples Together, But More Access to Health Insurance Seems to Free Them to Split

Married couples who have private health insurance, Sohn notes, are also likely to have more income and higher levels of education. The couples who have more money and are more highly educated are more likely to stay together, previous research shows. Sohn believes that these “traditional economic resources contribute to lower divorce rates by making the marriage more attractive.”

Access to health insurance is another kind of resource, similar to income and education. But having more access to health insurance, independent of a spouse, seems to free married people to divorce if that’s what they want.

That’s interesting, but the comparisons are not the same. For health insurance, one spouse’s dependence on the other for coverage is what was assessed. The same kinds of analyses, of the dependence of one spouse on the income provided by the other, would be useful. In any case, Sohn showed that her findings about health insurance and divorce could not be explained by factors such as the greater income or education of couples who have health insurance.

[Notes: (1) The opinions expressed here do not represent the official positions of Unmarried Equality. (2) I’ll post all these blog posts at the UE Facebook page; please join our discussions there. (3) For links to previous columns, click here.]