qotd: ACA not adequate to offset insurance loss from divorce

National Bureau of Economic Research
NBER Working Paper No. 20233
June 2014
Marital Disruption and Health Insurance
By H. Elizabeth Peters, Kosali Simon, and Jamie Rubenstein Taber

Despite the high levels of marital disruption in the United States, and
substantial reliance on family-based health insurance, little research
is available on the consequences of marital disruption for insurance
coverage among men, women, and children. We address this shortfall by
examining patterns of coverage surrounding marital disruption. We find
large differences in coverage across marital status groups in the
cross-section. In longitudinal analyses that focus on within-person
change, we find small overall coverage changes but large changes in type
of coverage following marital disruption. Both men and women show
increases in private coverage in their own names, but offsetting
decreases in dependent coverage tend to be larger. Dependent coverage
for children also declines after marital dissolution, even though
children are still likely to be eligible for that coverage. Children
and, to a lesser extent, women show increases in public coverage around
the time of divorce or separation. The most vulnerable group appears to
be lower-educated women with children because the increases in private,
own-name, and public insurance are not large enough to offset the large
decrease in dependent coverage.

New provisions in the Affordable Care Act (ACA) will increase
availability of health insurance, especially through Medicaid expansions
and subsidized exchange-based private coverage, and may mitigate some of
the detrimental impacts of marital disruption. However, because
employers are expected to remain the main source of coverage for the
nonelderly population (Congressional Budget Office 2012) and because of
lingering uncertainty regarding state compliance with expansions (Kaiser
Family Foundation 2013), marital disruption is likely to remain a cause
of instability in insurance coverage.

http://www.nber.org/papers/w20233

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Comment by Don McCanne

To no surprise, this study confirms that divorce is disruptive to health
insurance coverage, especially for spouses and dependent children. That
disruption is worse for more vulnerable lower-educated women with
children. Since employer-sponsored coverage is expected to remain the
most dominant form of insurance and most susceptible to changes due to
divorce, and since many states are avoiding compliance with the
intentions of improving coverage through the expansions authorized in
the Affordable Care Act, and since many divorced individuals and their
dependents will qualify for hardship exemptions allowing them to remain
uninsured, marital disruption will remain a significant cause of being
uninsured.

We are now inundated with reports about how well the Affordable Care Act
is working - the glass half-full argument. What about those who will be
left out because their share is in the empty half of the glass? We need
a full glass - a single payer national health program - but we didn't
get it. Many divorcees and their children will be victims of our
mediocre, half-assed effort (excuse me, half-glass). Well, it was
half-assed and it's time we said it.