The XX Factor

Obamacare Saved Marriages From “Medical Divorce”

Till death—not bills—us do part.


Divorce is rarely a sunny event, but so-called medical divorce is a particularly heartbreaking phenomenon. When one member of a couple under age 65 is diagnosed with a debilitating long-term illness, it can be financially responsible—even necessary—for them to divorce in order to push the sick partner’s assets below the threshold to qualify for Medicaid. Otherwise, the family’s retirement accounts and other savings could be consumed by health care bills, even if their income was relatively low. “A thousand little things have been ripped away from us,” said one Tennessee man who had separated from his epileptic wife in 2014 so she could qualify for the state Medicaid program. What a neat health care system we have here in America!

A paper published this week suggests that the Affordable Care Act has kept many of these imperiled marriages intact. The “asset tests” that incentivized divorce were removed under the ACA’s expansion of Medicaid. As long as the sick partner had an income below 138 percent of the poverty line, he or she could tap into Medicaid, and the healthy spouse could hold onto his or her retirement accounts. In the new paper, researchers compared the divorce rates between 2000 and 2015 in states that opted in to Medicaid expansion and those that didn’t. As it turned out, a state’s decision to expand Medicaid led to a 5.6 percent decline in the divorce rate among people age 50 to 64—the cohort most likely to fall prey to medical divorce. The paper, by two economists at the University of Kansas, was published by the National Bureau of Economic Research.

The researchers don’t claim to have conclusive proof that Medicaid expansion affected the divorce rate. For one thing, no one knows how common medical divorce was in the first place, in part because people who do it often feel compelled to keep their reasons secret in order to avoid punishment. But they write that their findings “strongly [suggest] that medical divorce was reduced in the first year of the Affordable Care Act.”

As a matter of fact, the Obama presidency was pretty great for marriage overall, and not just because the president himself made up half of the country’s most appealing married couple. The American divorce rate as a whole fell to a 40-year low in 2015, according to data released late last year. Meanwhile, marriage rates, which had been declining for decades, stabilized in 2010 and ticked upward in 2015. Oh, and by the way, marriage equality expanded access to the institution to millions of Americans for the first time.

Once you start looking around for ways in which traditionally progressive public policy is good for old-fashioned values, it can be hard to stop. Here’s another intriguing data point: The abortion rate has generally been sloping downward since 1980, but there is a remarkably consistent pattern within that larger trend. The most dramatic plunges have all come under Democratic presidents. Under Ronald Reagan and George H.W. Bush, the rate toggled between 24 and 23 abortions per 1,000 women of childbearing age. Under Bill Clinton, it plummeted from 23 to 16.2. Under George W. Bush, beloved by anti-choice activists as a champion of their cause, the rate essentially held steady. During Obama’s tenure in the White House, it dropped again, from 15 to 12.5 in 2013, the last year for which the CDC has issued data.

In January, a separate report by the Guttmacher Institute found that the abortion rate in the United States had fallen to its lowest level since Roe v. Wade. The findings were announced just a few days before the inauguration of thrice-married Donald Trump, who has vowed to repeal the Affordable Care Act and said that Roe v. Wade will be overturned “automatically” under his Supreme Court justices. It doesn’t bode well for family values.