The effect of the Affordable Care Act preexisting conditions provision on marriage

Abstract

This paper investigates the effect of the Affordable Care Act preexisting conditions provision on marriage. The policy was implemented to prevent insurers from denying insurance coverage to individuals with preexisting health conditions. We test whether the implementation of the provision led to decreases in marriage among affected adults. We add to earlier work on how marital behavior is influenced by spousal health insurance and examine for the presence of “marriage lock,” a situation in which individuals remain married primarily for insurance. Using longitudinal data from the Panel Study of Income Dynamics from 2009 to 2017 and estimating difference‐in‐differences models, we find that male household heads with preexisting conditions are 7.12 percentage points (8.9 percent) less likely to be married after the policy. Using information on insurance status prior to the policy change, we find significant reductions in marriage among individuals with preexisting conditions who were previously insured by spousal health insurance plans. The findings suggest that the inability to attain individual coverage and reliance on spousal insurance provided incentives to remain married before 2014.

The effect of the Affordable Care Act Medicaid expansion on marriage

“…Overall, our findings contribute to the small number of existing studies showing that certain provisions of the ACA influenced marriage decisions. In line with recent evidence on the dependent coverage mandate (Abramowitz, 2016) and the preexisting conditions provision (Hampton & Lenhart, 2019), we find that the expansions in Medicaid reduced the likelihood with which individuals are married, while increasing the likelihood of being divorced. Our findings are in contrast to the only other study evaluating effects of Medicaid expansion on marriage behavior (Slusky & Ginther, 2021), which focuses on medical divorce among a different population group, namely highly educated individuals between the ages 50 and 64.…”

“…More recently, Hampton and Lenhart (2019) study the impact of the 2014 ACA preexisting conditions provision on marriage. Given that the provision prevents insurers from denying coverage to those with preexisting health conditions, it presumably increases health insurance options for individuals as well as decreases reliance on spousal coverage.…”

“…Using longitudinal data to track individuals before and after the policy implementation, the authors find that, compared to healthy individuals, those with preexisting conditions were significantly less likely to be married and more likely to divorce following the policy. Additionally, Hampton and Lenhart (2019) find negative marriage effects among individuals with preexisting conditions covered by spousal health insurance plans prior to 2014, which furthermore indicates that these people may have been particularly reliant on their spouse to maintain health insurance coverage.…”

The effects of Medicaid expansion on home production and childcare

“…Further, health insurance is an important tool for managing financial risk (Antonisse et al, 2019), and in turn, Medicaid is associated with improved financial outcomes including reductions in out-of-pocket medical expenditures and bankruptcy and improved credit (Abramowitz, 2020;Glied et al, 2020). Medicaid expansion also reduced marriage and increased divorce rates, presumably due to a reduced need to obtain health insurance via a spouse (Hampton & Lenhart, 2019), but evidence also suggests that the ACA's insurance expansions reduced divorce stemming from high medical debt (Slusky & Ginther, 2021). Despite its impact on increasing household resources-presumably serving an income effect-Medicaid expansion appeared to have little impact on employment and labor market participation (Duggan et al, 2017;Gooptu et al, 2016;Kaestner et al, 2017).…”

Did Medicaid expansion reduce medical divorce?

“…The parental mandate that allowed young adults to stay on their parents' health insurance reduces marriage prevalence and increases the likelihood of being single (Chatterji, Liu, Yörük 2019), decreased childbearing and marriage rates (Heim, Lurie, and Simon 2017), and increased the prevalence of divorce (Abramowitz 2016). The ban on health insurers discriminating on pre-existing conditions also lowered marriage prevalence (Hampton and Lenhart 2019a).…”