Friday, November 16, 2012

Fwd: qotd: Divorce and women's risk of health insurance loss

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Subject: qotd: Divorce and women's risk of health insurance loss
Date: Fri, 16 Nov 2012 05:11:05 -0800
From: Don McCanne <>
To: Quote-of-the-Day <>

Journal of Health and Social Behavior
November 12, 2012
Divorce and Women's Risk of Health Insurance Loss
By Bridget Lavelle and Pamela J. Smock


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.

Comment: 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.

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