How Health Care Costs Keep Me From Getting Married

I always wanted to get married, even when I didn’t.

Before I was 4, my mother and father called it quits. By the time I was 8, my mother separated from her second husband, who then skipped town altogether. My early life was marked by the abandonment of men who split when things became too hard, leaving my mother in a financial and emotional lurch out of which she couldn’t climb.

As a surly and somber teen, I sneered with contempt whenever marriage was referred to as a sacred ceremony in my all-girls Catholic high school — all the while secretly hoping I could one day forge my own family with stronger bonds than the one I was born into. I wanted to find someone who loved me enough to see through my scars and publicly pledge lifetime loyalty by committing themselves to me on paper.

In 2015, it seemed I had finally found him — but my body had different plans. Around the time we started dating, I developed health complications from several pre-existing conditions: nerve pain and numbness, intermittent muscle tremors, and vertigo that sometimes endured for days. Out of concern, he moved from several towns away to across the street. But that might be as close as we can ever get. Our shared goal of getting married is now up in the air — and not because we don’t want to, but because it would likely bankrupt us.

Love isn’t logical, so most people don’t usually consider the potential financial fallout of their romantic decisions, whether that be entering a legal marriage or a domestic partnership, but my situation demands it. Marriage would force me off the social safety nets I need to live independently — like Medicaid and rent-controlled, affordable housing — and my partner’s income would not be enough to compensate for those losses in the long-term. In fact, those losses would likely send us into hundreds of thousands of dollars’ worth of debt.

[quote position="full" is_quote="true"]Our shared goal of getting married is now up in the air — and not because we don’t want to, but because it would likely bankrupt us.[/quote]

In the past year, I had four MRIs, a nerve conduction test, and countless rounds of blood work, all of which were completely covered under the Affordable Care Act’s Medicaid expansion in Massachusetts. If I were married, I would have to be on my partner’s employer-provided insurance, which, while OK for the average healthy person, might mean forking over hundreds (if not thousands) each month in co-pays and deductibles — money I don’t have as a freelancer. My weekly doctor, acupuncture, and chiropractor visits, which I need to manage chronic pain, currently cost nothing.

Today, I could have the hip surgery and hysterectomy my doctors have recommended and receive no bill whatsoever. But this wouldn’t be an option if I were married and on my partner’s insurance. Those tens of thousands of dollars we would likely be billed would instead force us into medical debt.

My health problems limit the amount I can work — and consequently the amount I can make — which means my partner would have to take on not only most of my medical expenses, but the financial burden of being the primary breadwinner, as well.

My boyfriend makes a decent salary, but it only goes so far where we live in the Boston metro area, which has the third-most-expensive rental market in the nation and where the average person must earn the full-time equivalent of $50 an hour to afford a one-bedroom apartment. Even though we reside in the slightly cheaper suburbs, rental prices still would leave little left over for my medical expenses. We’ve considered moving south to the Carolinas, where he is originally from and where the cost of living is far cheaper. But unfortunately, there are few opportunities in his professional field in that region. Plus, the benefits packages can be even stingier than what he has up here. Most southern states — including North and South Carolina — have opted out of Medicaid expansion, so I would not qualify for the same type of health insurance I’m receiving now if we were to move there as a cohabitating couple.

All of this means marriage is off the table right now.

For other couples, marriage is one of the few surefire ways to ensure legal protections like entitlements to Social Security, shared property, retirement funds, and other assets in case of emergency. But for me, because of my medical issues, marriage would do more to harm me and my partner than it would to protect us.

Photo by Marta Nimeva Nimeviene/Flickr Creative Commons

I am not alone in this emotional and financial struggle: a third of Americans between the ages of 18 to 60 claim to know at least one person who has not married for the same reason: fear of losing means-tested government benefits. In fact, 82% of American lower-middle-class households with young children would lose benefits they rely on to survive, like cash welfare and food stamps, upon marrying. This marriage penalty also disproportionately affects millions of disabled people living in the U.S. who depend on Social Security disability income (SSI or SSDI) and crucial but expensive services covered through Medicare and Medicaid for their survival.

“Getting married is basically like a social welfare policy for the middle class, and for the rich, it even equates to this luxury good,” explains Sarah Wright of Unmarried Equality, a nonprofit that advocates for legal rights and protections for unmarried couples. “But for people who are financially struggling, there are some real risks if you tie the knot.”

It can be even riskier when health issues are added into the mix.

Last year, a poll conducted by The New York Times and the Kaiser Family Foundation found that 20% of people under 65 with health insurance were battling medical bills, with 39% having insurance through their employer. Considering that health insurance premiums rose by 83% from 2005 to 2015 while the amount employees pay for their deductibles increased by 255%, it’s no wonder that medical debt is responsible for the majority of bankruptcy claims in the U.S.

It also may account for why “medical divorce” (aka “Medicaid divorce”) is still a phenomenon in the U.S. When one person’s health suddenly declines or their employer benefits are suddenly lost, couples are forced to break their legal marriage in order to stay financially afloat. Take Cassandra Perry, who has Ehlers-Danlos syndrome, post-traumatic stress disorder, and narcolepsy. A few years ago, she divorced her husband of six years to re-qualify for Medicaid. As she told The Washington Post, there weren’t any other options: Her health had declined to the point where she could no longer work and her husband lost his job with good benefits, making even the cheapest private insurance plans available on the ACA unaffordable to them. Perry’s diagnoses require 19 prescription medications to manage, plus annual surgeries and hospitalizations — divorce was the only way to stay alive.

[quote position="full" is_quote="true"]I would end up being a financial punishment to my partner, who works so hard and cares for me so much already.[/quote]

Perry’s story, sadly, isn’t new or surprising for those of us with significant health issues; her case merely serves as a cautionary tale for couples who are considering marriage.

Like me, 28-year-old Annie, who struggles with Ehlers-Danlos syndrome as well as psoriatic arthritis, has indefinitely postponed marriage. She too relies on government programs to manage her disabilities: the Motability car she needs to get around, for example, is completely covered. Otherwise, she’d have to pay $18,650 for the device — which is about half of her partner’s annual salary.

“I would end up being a financial punishment to my partner, who works so hard and cares for me so much already,” says Annie. “I do not understand the outdated rules where a declaration of love makes you wholly responsible for your partner's financial well-being.”

For now, Annie continues to wear her partner’s ring, and the two are considering having a non-legal ceremony to celebrate their relationship. This is similar to the plans my own partner and I have as an alternative to marriage: to eventually live together, exchange rings, and even have our own “commitment ceremony” — basically a wedding minus the marriage license. But none of those go far enough in offering some of the financial protections that come with legal marriage. For that, we would need a co-habitation agreement.

Co-habitation agreements lay out legally binding terms for how household costs and duties are to be divided during the relationship and what happens in the event of unforeseen illness, separation, or death. These are basically prenuptial agreements without the nuptials. In the absence of a legal marriage, a formal written contract is the only other way to ensure unmarried couples have similar protections as their married counterparts.

I already had one long-term, live-in relationship go bust where the unequal financial dynamics left me in a vulnerable position. I want to be extra cautious going into my next one, especially as my health status raises the stakes. Since I don’t have the luxury of not thinking practically, my partner and I bought books on legal agreements for unmarried couples and began to brainstorm our conditions and demands for the relationship — both for while we remain together and in case we separate. This written contract will include how to divide expenses proportionate to our individual incomes and ensure I am entitled to some sort of palimony (which is basically alimony for a former unmarried partner) if things don’t work out.

This may seem unromantic to many, but it’s someone who is willing to commit himself to me, even though the “sickness” part of “in sickness and health” has already been discovered. And while I am angry to live in a society that forces so many disabled people to choose between marriage and adequate health care, I am determined to not let money become a barrier to love and loyalty.