By Bridget Lavelle and Pamela J. Smock
Journal of Health and Social Behavior, November 12, 2012
Abstract
This article bridges the literatures on the economic consequences of divorce for women with that on marital transitions and health by focusing on women’s health insurance. Using a monthly calendar of marital status and health insurance coverage from 1,442 women in the Survey of Income and Program Participation, we examine how women’s health insurance changes after divorce. Our estimates suggest that roughly 115,000 American women lose private health insurance annually in the months following divorce and that roughly 65,000 of these women become uninsured. The loss of insurance coverage we observe is not just a short-term disruption. Women’s rates of insurance coverage remain depressed for more than two years after divorce. Insurance loss may compound the economic losses women experience after divorce and contribute to as well as compound previously documented health declines following divorce.
From the Discussion
Not all women are equally likely to lose health insurance after divorce. Those insured as dependents on husbands’ employer-based insurance plans are most vulnerable to insurance loss, while stable, full-time employment buffers against it. Women from moderate-income (200–300% FPL) families are particularly vulnerable. Many of these women fall into the ranks of the near-poor after divorce, with too much money to qualify for Medicaid but not enough to purchase private health insurance coverage.
Our findings also add to the body of evidence that the current health care and insurance system in the United States is inadequate for a population in which multiple family and job changes over the life course are not uncommon. It remains to be seen how effectively the Affordable Care Act (ACA) of 2010 — expected to be fully implanted by 2014 — will remedy the problem of insurance loss after divorce.
Moving forward, policy makers should be aware that a system that induces a de facto linkage between marital status and health insurance may have unintentional adverse consequences.
http://hsb.sagepub.com/content/early/2012/11/09/0022146512465758.full.pdf+html
Comment:
By Don McCanne, MD
For a wide variety of reasons, our bizarre, fragmented, though expensive system of financing health care leaves many people vulnerable to financial hardship and impaired access to care. This study shows that women who divorce are at great risk of becoming uninsured and consequently may compound both economic losses and health declines.
Even within the population of divorced women multiple factors play a role in whether or not the person is insured, or in what form of insurance the person may have – whether it is public or private, employer-sponsored or purchased in the individual market. Even if insured, the variations in coverage can disrupt established relationships with health care professionals because of non-congruent networks, and can expose the individual to a wide range of potential financial barriers because of the differences in cost sharing with the various forms of coverage.
Will the Affordable Care Act (ACA) correct these deficiencies? Some lower-income individuals may be eligible for Medicaid, but many states have indicated that they will not use the provisions of ACA to expand eligibility for the program. Divorced women with modest incomes may find that their incomes are too high to qualify for Medicaid, yet still too low to be able to pay their share of the premium after any subsidies. Some may be exempt from the requirement to purchase insurance, while others may be subject to a penalty for not having insurance, even though they simply do not have adequate funds to pay the premiums. In either instance, they will remain uninsured.
As the authors of this report state, “policy makers should be aware that a system that induces a de facto linkage between marital status and health insurance may have unintentional adverse consequences.” That statement can apply to the innumerable other factors that determine whether or not a person is covered, and, if so, by which of the highly variable public and private forms of coverage that differ in their ability to ensure both access and financial security.
Everyone should automatically have full coverage for life. Divorce, and all of the other variables throughout life, should have absolutely nothing to do with a program designed to prevent greater financial insecurity in the face of health care needs. We need to improve Medicare and provide it for everyone, automatically, for life.