It's Not Just Love: Some Stay Married for the Health Insurance

People dependent on a spouse for health insurance are less likely to divorce.

Posted Mar 03, 2021 | Reviewed by Gary Drevitch

I’ve never been married and I don’t ever want to, but if I got hit on the head with a rock and changed my mind, I think I’d want to marry for love. I know that’s sappy and conventional, and I am not a sappy or conventional person, but remember that in this scenario, I have been hit on the head with a rock.

I don’t think anyone should have to marry for reasons that shouldn’t matter – for example, that marrying gives them the best shot at affordable health insurance. And yet, there is evidence to suggest that factors like that do matter. For example, once the Affordable Care Act was passed and young adults could stay on their parents’ heath care plan until they were 26, those young adults were less likely to marry than they were before.

I don’t think anyone should have to stay married for reasons that shouldn’t matter, either. Do they? Does health insurance factor into married people’s decisions about whether to divorce? Apparently, it does.

Tracking the Divorces and Access to Health Insurance 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 three years before the Affordable Care Act was passed. Even now, though, most people with health insurance are covered by their employer rather than by the ACA 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 focused on 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 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 married women than 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 that 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. Even taking those kinds of factors into account, being dependent on a spouse for health insurance keeps some people in marriages they may not want to stay in, and having independent access to health insurance frees some others to leave the marriage if that’s what they want to do.

This post was adapted from a column published at Unmarried Equality (UE), with the organization’s permission. The opinions expressed are my own. For links to previous UE columns, click here. See also, “How affordable health insurance improved the lives of single people.”