If the Republican plan to
replace the Affordable Care Act (ACA) becomes law, it could not only affect people’s health insurance but possibly their marriages as well.
It all depends on what happens with Medicaid, the federal health plan for low-income Americans ages 65 and younger. Under the ACA,
Medicaid was expanded in 31 states and the District of Columbia to cover individuals and families making 138 percent of the poverty line ($34,000 for a family of four), regardless of their assets.
The Medicaid expansion helped all kinds of adults gain or retain health-care coverage. It particularly helped couples where one spouse was well and the other sick, so that the sick person’s health-care costs would not bankrupt the couple of all their assets or make it difficult to maintain health insurance. Before the Medicaid expansion, to qualify for
Medicaid, the sick person had to show no assets or income.
In these situations, some couples were faced with a difficult choice: They could slowly draw down assets such as retirement accounts or home equity to pay their medical bills; or they could go through what’s called a “medical divorce,” splitting up legally so that the sick partner could enroll in Medicaid and the other person could retain their assets. Typically, these couples remained “together” and continued to care for one another; the divorce was merely on paper.