How Affordable Health Insurance Improved the Lives of Single People
The chances of being insured, getting married, and having babies all changed after the Affordable Care Act was passed
Those of us who are single are stuck putting up with the stereotyping and stigmatizing that I call singlism. Tell someone you are single and from knowing just that one thing about you, many people will immediately assume that you are miserable, lonely, self-centered, and immature. They would be wrong about all of that, as research shows.
Stereotyping is hardly the worst component of singlism. People who are single are also disadvantaged in important ways — for example, in their access to health insurance.
Since Obamacare Was Enacted, Fewer Single People Are Going without Health Insurance
In some countries, access to health care comes with citizenship or residency. That doesn’t happen in the United States, where many have no health insurance and there are substantial inequalities across groups. For a long time, unmarried Americans have been among the groups least likely to have health insurance. In a study published in 2018 in the American Sociological Review, public policy professor Carmen Gutierrez of the University of North Carolina at Chapel Hill asked whether Obamacare — the Patient Protection and Affordable Care Act (ACA) — has been particularly beneficial to unmarried Americans.
She found that it has. Using data from the National Survey of Drug Use and Health, Professor Gutierrez showed that fewer unmarried Americans were uninsured in the three years following the enactment of Obamacare (2014 through 2016) than in years before (2009 to 2012). Obamacare was also particularly beneficial to people without full-time jobs. In addition, Gutierrez noted, “the ACA helped to significantly narrow health insurance inequalities across gender, race and ethnicity, and education.”
In the years before Obamacare (2009–2012), 19.7 percent of all adults between 18 and 64 had no health insurance. In the three years afterwards (2014 through 2016), that number dropped to 13.6 percent.
All adults (ages 18–64), married and unmarried
19.7% uninsured before Obamacare (2009–2012)
13.6% uninsured after Obamacare (2014–2016)
Before Obamacare, when nearly 20% of the adult population was uninsured, the share lacking coverage was even higher among those who were not married, nearly 27%. Afterwards, the share of unmarried Americans who were uninsured fell to about 18%. That’s a change of 33% (27–18/27).
26.7% uninsured before Obamacare
17.9% uninsured after Obamacare
Professor Gutierrez also looked separately at how much Obamacare mattered for unmarried White, Black, and Latino Americans. In all three groups, the percentage of uninsured people dropped substantially. Unmarried Black Americans benefitted the most; their uninsured rate was cut by more than half, from 25.1% uninsured before Obamacare to 12.3% uninsured afterwards.
Married people benefited from Obamacare, too. Just over 13% of them were uninsured before Obamacare, compared to just over 9% afterwards. That’s a change of about 30%.
13.3% uninsured before Obamacare
9.3% uninsured after Obamacare
Even in the years after Obamacare, unmarried Americans are still more likely than married Americans to be uninsured. But the disparity is not quite as wide as it once was. (Before Obamacare, 26.7% of unmarried Americans were uninsured, versus 13.3% of married Americans. Afterwards, 17.9% of unmarried Americans were uninsured, versus 9.3% of married Americans.)
Why Was Obamacare Particularly Important to Single People?
If everyone had access to health care, then marital status would not matter. But even without universal benefits, it would be possible to devise a system that did not systematically disadvantage single people. In the U.S., though, marital status has traditionally been one of the main ways that people could access health insurance. If they are married to someone who gets health insurance through their employer, sometimes they can get added to that plan. Single people are typically left out of that route to coverage — no one can add them to their plan.
That path to health insurance is still available, post Obamacare. But the Affordable Care Act also offered plans in the Health Insurance Marketplace that single people could purchase independently of a spouse, plans that were typically more affordable than the private plans that existed before Obamacare. The ACA also provided subsidies to many people who needed them. That, too, was especially important to single people, who tend to be less well-off financially than married people. (Systematic discrimination plays a role in that, too.)
Before Obamacare, some people of limited means could access insurance through Medicaid. For example, parents with dependent children and pregnant women could get Medicaid as long as their income was extremely low, “often below half the poverty level.” For adults with no children, access to Medicaid was even more restricted. As Gutierrez noted:
“In 2009, childless adults with income below the poverty line were eligible to qualify for coverage comparable to Medicaid in just five states.”
Obamacare was designed to expand Medicaid, so that all adults (and not just parents) with a household income up to 138 percent of the federal poverty line were eligible. A Supreme Court ruling allowed states to opt out of Medicaid expansion, so the ACA does not cover as many people as it would have without that ruling. Still, the net effect for single people — especially singles with no children — has been very positive.
What Obamacare Meant for Young Adults
Contemporary marriages are supposed to be about love. Sometimes, though, practicalities matter more. When marriage offers an affordable route to health care that is otherwise unavailable, some might just marry for the health insurance.
For young adults, the Affordable Care Act offered a new provision — the opportunity to stay on their parents’ health insurance plans until they were 26 years old. Did that ease the pressure to marry? That’s what Joelle Abramowitz of the University of Michigan Survey Research Center asked. Analyzing data from the American Community Survey, Abramowitz found that young people were less likely to have married after that provision of the ACA was passed than they were before. Marriage rates have generally been decreasing over time, but that does not account for her results, because the rate of marriage decreased more for young adults than for slightly older ones.
She also found “a temporary spike in divorce following the enactment of the provision, as well as fewer people cohabiting.”
After the provision of allowing young people to stay on their parents’ plan was enacted, two other things changed for young women: They had fewer babies and they also had fewer abortions. Abramowitz believes those changes happened because women were much more likely to use “long-term hormonal birth control.” She thinks they “switched from less effective but less expensive contraceptive methods, like condoms, to more effective but more expensive ones.”
Joelle Abramowitz believes these changes are for the better:
“…people who do not need to take health insurance into account when deciding whether to get married are likely to ultimately enter into happier and better marriages. People who have more control over family planning have the ability to better invest in careers and education and to start families when they are ready.”
Of course, I would add that people can also decide not to get married at all, and not to start families at all — and it is also a good thing that those options are available.
This story was adapted from a column originally published at Unmarried Equality (UE), with the organization’s permission. The opinions expressed are my own. For links to previous UE columns, click here.
Want to learn more? Take a look at this collection of articles on all sorts of topics relevant to single life. Watch my TEDX talk, “What no one ever told you about people who are single.” Check out my website. Find my other stories on Medium here. Disclosure: Links to books may include affiliate links.