Monday, June 28, 2004
'I do' — for a health plan
A story published today in the Los Angeles
Times reports that many couples are getting married so that one partner
can gain access to the other's health insurance benefits.
Consider Tamra Crume who had little
intention of marrying again. She tried it once before, in her early 20s,
and thought the whole idea was outdated, oppressive, unnecessary.
But there they were last New Year's Eve, she in her short sleeve,
off-the-rack sea-green dress, her partner of a dozen years, Keith, in a
gray suit from the closet, driving 45 minutes to a suburban Maryland
courthouse to say "I do." Why the sudden change of heart?
"I needed health insurance," says the 38-year-old catering manager, who
was so nonchalant about her nuptials she bought a cheap disposable camera
for pictures on the way. She took one photo: It came out fuzzy and cropped
her at the knees.
Crume had moved from Oregon to Washington, D.C., two years ago and
couldn't find work. Her doctor and prescription bills were running several
hundred dollars a month. Her boyfriend's generous government insurance
benefits looked more and more attractive.
"I figured it made more sense to pay the money to get married rather than
keep paying the bills," she says.
Love and marriage may go together like a horse and carriage, but for some
couples a dance down the aisle these days may have more to do with dollars
and cents. Although no one keeps statistics on how many couples marry each
year to gain access to health benefits, there are signs the arrangements
are growing among people who can't afford medical coverage and those
struggling under the burden of rising insurance premiums.
Advertisements on the New York City subway this month by a group promoting
affordable health insurance read, "Get Married for Love, Not Health
Insurance." Internet chat rooms are filled with people communing about the
benefits of marrying for health benefits and trading tips on how to do it
right. (Fees for marriage licenses and other costs can vary considerably
depending on where people get married.) Some patient advocacy groups,
including the American Diabetes Assn. and the American Cancer Society, say
a small but growing number of seriously ill people are using marriage as a
last resort to deal with potentially crippling medical bills.
The recent legalization of gay marriage in Massachusetts also could lead
more couples to marry for medical benefits. Last month, town managers in
Springfield, Mass., stopped offering domestic partner benefits to
unmarried couples and gave them 90 days to marry if they want to keep
their insurance benefits. Other Massachusetts employers, including Boston
College and Beth Israel Deaconess Medical Center in Boston, are ending
partner benefits by the end of the year.
Unlike the 1990 movie "Green Card," in which two strangers marry so one
can stay in the country and then later fall in love, most couples who
marry for insurance reasons have been together for years. Many explicitly
didn't want to get married — or at least had not planned to wed so soon.
Occasionally, friends marry friends or a single parent with a sick child
and mounting medical bills finds someone to marry and agrees to pay the
extra insurance costs.
Experts say those marrying for health insurance should be careful.
Although the long-maligned "marriage tax" has been reduced in recent
years, financial experts say some couples may still pay significantly more
in income tax once they're married. What, too, if love ever wilts? Divorce
lawyers recommend couples marrying explicitly for insurance reasons have a
prenuptial agreement in case the relationship sours down the road.
Drew Tipson and his wife, Emma Brooks, had been in a relationship for
years but didn't consider marriage until last year, when Tipson began
having intense pain in his neck and head, which doctors still haven't
explained. Tipson, 26, is a freelance worker for a Manhattan law firm and
doesn't qualify for health insurance. Brooks, a 25-year-old medical
student, has health insurance, but her plan doesn't cover unmarried
domestic partners unless they are gay.
So, just weeks after telling their parents they probably would never
legally marry, the two families found themselves together at a New York
City courthouse during Tipson's lunch break. The 10-minute civil ceremony
wasn't the wedding his parents might have imagined.
"The most tragically bored woman in history read out the ceremony script
in a nondescript room that could have been a police interrogation
chamber," he says. Afterward, "the two of us left and headed down
different subways to go back to work. I think my parents were left
standing there thinking, 'What in the heck just happened?' "
People with disabilities or facing life-threatening illnesses face higher
stakes. John Bennett, 34, of Cincinnati married his longtime partner two
years ago. She has multiple sclerosis and lost her insurance after
finishing graduate school in 2001. Without dual coverage, Bennett says,
the couple could face financial ruin if his wife has another flare-up of
her MS, which last happened three years ago. She already filed for
bankruptcy protection after she was first diagnosed a decade ago and
didn't have insurance.
The pair has saved thousands of dollars in insurance costs so far. It now
costs $200 a month to insure them both, instead of the roughly $500 a
month that Bennett's wife would pay just to cover herself, because of her
preexisting condition. "We needed a safety net," he says.
According to the Henry J. Kaiser Family Foundation, a health policy group
based in Menlo Park, Calif., health insurance premiums rose 13.9% last
year, the third consecutive year of double-digit increases. The average
cost of coverage for a family of four is $9,100 per year, and the average
individual insurance plan runs $3,400 a year. Considering that an
estimated 44% of Americans lack health insurance, it's easy to see why
some people might turn to marriage to get access to insurance.
Kathleen Stoll, director of health policy at Families USA, a Washington,
D.C.-based health consumer group, says the rising cost of health insurance
is increasingly affecting people's lifestyle and career decisions: having
more children, where to live, changing jobs or going back to school. She
says it's not uncommon for couples to divorce so one can qualify for
coverage through Medicaid.
"Getting married for insurance may sound silly," she says, "but it's no
joking matter. It's a serious example of just how difficult getting
affordable health insurance is for most people."
Although companies are not required to offer employees health insurance,
if they do they must cover an employee's spouse no matter his or her
medical history. But a growing list of employers, from Boeing Co. to the
University of California system, have recently started asking employees to
pay significantly more if they want to cover family members.
In most states, common law marriages are of little use because insurers
typically won't include a common law spouse on an employee's health plan.
Dave Hennings, a spokesman for the National Health Care Anti-Fraud Assn.
in Washington, D.C., says it's unlikely insurers would deny coverage to
anyone who marries for insurance benefits. "I think most people would
agree this doesn't rise to the level of fraud," he says.
There are proven advantages to tying the knot. For example, studies show
married couples live longer than those who only live together. Married
couples also benefit from visitation rights at hospitals and the ability
to will a partner an estate without paying capital gains tax.
Still, couples who married solely or largely for medical benefits don't
always tell their families or friends that they are married — or why they
married. Many don't wear rings, take each other's names or go on
honeymoons. Some keep their marriage under wraps because they worry that
others might minimize their relationship if they knew the reason for the
wedding, or that family members might get angry.
"This is our dark secret," says Bennett, who says he and his wife have
mentioned their marriage only twice, to their doctor and to his company's
human resources manager. Recently, he had to look at their marriage
license to remember their wedding date.
Marijah Sroczynski and Paul Adams of Orange, N.J., married five years ago
so he could work as a freelance sound engineer in New York theaters, a job
that doesn't provide insurance. She rarely mentions she's married.
Adams, however, sometimes jokes about his marriage to his uninsured
friends in the theater world. "He loves to pull out his insurance card
when they are complaining about not having insurance," Sroczynski says.
"He tells them it's the best reason to get married."