Unconventional Solutions: How Some Americans Are Navigating Healthcare Costs
Healthcare costs in the U.S. have led some individuals to take unexpected steps to secure needed insurance coverage. Mathew, a resident of Michigan, finds himself in a unique situation reminiscent of a rom-com plot. “For me to be able to see my doctor to tend to my autoimmune disease, I had to marry my best friend,” he shares, noting the parallel to a “weird twisted plot of Will and Grace.”
Mathew, who requested anonymity to avoid potential backlash from his insurer, is among those who have entered into marriage to obtain health insurance. This is not a novel concept in America, especially given the reliance on employer-sponsored insurance before the Affordable Care Act (ACA). Many have delayed divorces or made career decisions based on insurance needs.
The expiration of enhanced subsidies at the end of 2025 for ACA marketplace plans has left millions facing steep premiums. These were initially introduced to make healthcare more affordable, but without congressional action to extend them, many find the costs prohibitive.
Some individuals, like Mathew, have opted for unconventional measures to maintain coverage. Unable to wait for a legislative resolution, he chose to marry his longtime friend Christina. “I couldn’t afford to wait for Congress to make up their minds and come to an agreement,” Mathew explains.
Taking Unusual Steps
At 40, Mathew resides in a Michigan town and works for a small business that does not offer health benefits. His autoimmune condition necessitates costly medication transfusions, making insurance essential. Prior to the subsidy expiration, his ACA plan was affordable at $181 a month. However, the anticipated increase to $427 made it unmanageable.
Christina, Mathew’s roommate of 25 years, proposed a solution. With comprehensive insurance through her employer, she suggested they marry. Despite being a non-romantic partnership, their decision was driven by practicality. “We share the burdens of day to day life and we have for over 15 years of living together and 25 years of friendship,” Mathew notes.
After much consideration and consultation, they held a small ceremony, allowing Mathew to access a plan costing $121 monthly. His new health coverage began in January, though he faces the challenge of transitioning his care quickly.
Marriage for Benefits: A Legal Option
Marriages for insurance benefits, though less common post-ACA, are legal. Erin Fuse Brown, a health law professor at Brown University, explains, “With the expiration of the enhanced premium tax credits, we’re now starting to slowly walk back toward a pre-ACA world.” She emphasizes that marriage motivations can be diverse, including economic and practical reasons.
Mathew’s situation highlights the current healthcare affordability crisis. He remains hopeful for a congressional solution, aware that not everyone has the option to marry a friend to secure necessary coverage.
For more on healthcare coverage challenges, visit NPR’s coverage on ACA subsidies.
