奥巴马医改对婚姻的隐性惩罚

Childless couples and empty nesters pay more. Much more.

The first time I heard Nona Willis Aronowitz talk about getting divorced to save money on health insurance I thought she couldn't really be serious. We were at Monte's, an old Italian place in South Brooklyn, having dinner with a group of New York women writers in late July.

"Don't do it!" I urged her, certain, having watched my friends over the years, that no matter how casually she or her husband might treat the piece of paper that says they are married, getting unhitched would inevitably change their relationship as profoundly as getting hitched in the first place.

But with the arrival of the Affordable Care Act's insurance exchanges, the question for Nona and her husband Aaron Cassara moved from the realm of casual conversation to a real financial conundrum. Aged 29 and 32, respectively, they were facing tough times for their professions, a wildly expensive city, and the scary prospect that both of them could shortly be uninsured. Right now Nona only has a COBRA plan—"which I can barely afford"—that ends January 1, she tells me. Her last staff job ended when the media outlet she was working for laid off its whole editorial team; she's been a full-time freelancer since. Aaron, a filmmaker who works part-time and also freelances, has been uninsured since her layoff, because it would be too expensive to have him on COBRA too.

Any married couple that earns more than 400 percent of the federal poverty level—that is $62,040—for a family of two earns too much for subsidies under Obamacare. "If you're over 400 percent of poverty, you're never eligible for premium" support, explains Gary Claxton, director of the Health Care Marketplace Project at the Kaiser Family Foundation.

But if that same couple lived together unmarried, they could earn up to $45,960 each—$91,920 total—and still be eligible for subsidies through the exchanges in New York state, where insurance is comparatively expensive and the state exchange was set up in such a way as to not provide lower rates for younger people. (Subsidy eligibility is calculated using a complicated formula involving income in relation to the poverty line, family size, and the price of plans offered through a state's marketplace.)

Nona and Aaron's 2017 income was higher than the 400 percent mark, but not by much. In New York City, that still doesn't take you very far for two people. If their most recent months of income are in the same range, they will get no help at all with buying insurance through the exchanges if and when they apply, according to the Kaiser Family Foundation and eHealth subsidy calculators. Premiums for the two for silver-level plans came in at $9,248 for the year.

But if they applied as unmarried individuals with something like their 2017 income, one of them would get at least $3,964 in subsidies toward the purchase of a plan, or possibly even be eligible for Medicaid, thanks to their uneven individual earnings that year. And if they fall below the 400 percent threshold, which Nona says they might this year, they could get substantial subsidies as a couple that are still worth less than what they'd be eligible for as individuals. These gaps are the marriage penalty.

Married people who are uninsured make up just a small fraction of the uninsured, for obvious reasons: It is easier to be insured if you have two potential pathways of getting there. Only 15.4 percent of married people were uninsured 2017, according to research from the Kaiser Family Foundation; the uninsurance rate for "single adults living together" was more than twice as high—33.4 percent.

That may be one reason the Obamacare subsides are more generous to single people and one- or two-parent families with children in the house than to couples who lack children. They were designed to help single moms and struggling middle-class families with children, not married creative-class millennials in pricey cities who have not yet settled into well-paid work, or barring that, work for a single employer.

Health insurance isn't the only place where there's a marriage penalty. The federal income tax also hits married couples with similar earnings harder than couples with one main breadwinner.

"In the tax code, you have a different set of tax rates for married couples that mitigates the marriage penalty to some degree," says Robert Rector, a senior research fellow at the Heritage Foundation who has been writing about the marriage penalty in health reform since 2010. Under Obamacare, however, there are "dramatic" penalties that are "substantial—particularly with couples in the upper age range," he says.

"What you are doing is saying ... you have to pay a penalty of multiple hundreds of dollars—a substantial portion of your income—to stay married," Rector says. "It's saying society is basically hostile to the institution of marriage."

Experts on the impact of marriage penalties were skeptical that many couples would consider divorce over insurance rates. Still, there is some data to suggest that marriage penalties embedded in government programs can discourage marriage among those who are benefiting from programs that favor the unmarried.

"The received wisdom in public finance is that marriage per se can be financially discouraged if both members of a couple have decent earnings potential and would face a higher combined tax rate as a married couple than as a pair of singletons," explains Gary Burtless, a senior fellow at the Brookings Institution. "At the lower end of the income scale, if the combined earnings potential of the couple is not very promising, marriage might prevent the mom and kids from receiving as much government assistance as they can receive if the adult couple remains unmarried."

There's no data yet on the potential size of the population potentially affected by such concerns under the Affordable Care Act, but Medicaid and other means-tested programs "already created that kind of potential marriage penalty," he notes. At least half of the newly insured under ACA will be insured under Medicaid.

The great irony, Nona explains, is "we wouldn't be married if it weren't for a situation that happened in 2009 where he needed health insurance."

Despite its administrative beginnings, their City Hall marriage has lasted so far. Aaron was on Nona's insurance at first; later, when their job arrangements changed, she was on his. Now Nona is looking to land a full-time staff job, in hopes of once again having an employer-based plan that Aaron, too, can join.

"I guarantee you that in six months I will either be divorced or I will have a full-time job," she says.

无子女夫妇和空巢老人支付“罚款”更多，而且多得多。

第一次听到诺娜·威利斯·阿罗诺维茨谈起要离婚来为健康险存钱时，我想她一定是在开玩笑。那时是六月下旬，我们正和一群纽约女作家在蒙特吃晚餐，那里位于南布鲁克林区的一个意式地方。

我当然劝她千万别这么做。这些年来我也曾目睹我的朋友们经历离婚。不管她或是她的丈夫觉得这张宣告他们结婚的纸张其实不重要，他们之间的关系都会随着离婚而不可避免地产生很大变化，就像当初他们结婚时一样。

然而随着平价医保法案保险交易的实行，诺娜和她的丈夫亚伦·卡萨拉面临的问题从休闲的谈话境界转移到一个真正的金融困境。他们今年分别是29岁和32岁，住在一个极度昂贵的城市又遇到了工作上的艰难时刻，更可怕的是他们的保险即将到期。诺娜告诉我她现在只有一个到一月一号停止的统一预算协调法案规定的健康险，但她也几乎无法负担了。她的上一份员工工作结束了，因为媒体透露她在为一整支解雇了的编辑团队而工作。之后她就成了一名专职自由作家。亚伦是一名兼职电影制片人同时也是一位自由作家，自从妻子失业后，他就已经不投保了，因为那太昂贵了。

如果任何一个两口之家的夫妻收入超过联邦贫困线四倍即62040美元，根据奥巴马医改他们将得到很多补贴。凯萨家庭基金会的医疗保健市场项目负责人，加里·克拉克斯顿表示“如果你的收入在贫困线四倍以上，那么你就不符合高级支持的条件”。

反之如果同样的一对儿住在一起但不结婚，他们每人可以挣到45960美元，加起来也就是91920美元，但他们仍然有资格通过纽约州的保险交易获得补贴。要知道这里的保险相对来说很昂贵,而且这个州的交易建立在不给年轻人提供更低利率的方式上。（补贴资格的计算用了一种很复杂的方法，涉及到收入水平与贫困线和家庭人数的比较，并且补贴通过这个州的市场发放。）

诺娜和亚伦2017年的收入略高于四倍线。在纽约，这样的收入水平仍然无法让两个人过得很好。根据凯萨家庭基金会和电子健康补贴的计算显示，如果他们最近几个月的收入在还同样的范围内，那对他们申请补贴毫无帮助。两个人为白银级别的保险一年要支付9248美元。

但如果他们以未婚的个人身份和一些别的条件类似于2017年收入来申请的话，一个人就能得到至少3964美元的购买保险的补贴，或者甚至有可能有资格申请医疗补助，这都得归功于这一年时好时坏的个人收入。若是他们的收入不足四倍线，诺娜说今年就有可能，那俩人能获得大量的津贴，当然作为个体申请依然比用夫妻身份申请得到补助的多。这些差距是对婚姻家庭的罚款。

未投保的人中已婚的只占一小部分，理由显而易见：如果你有两条可行的路可走，投保会更容易。据凯萨家庭基金会的调查显示，2017年已婚人士中只有15.4%未投保；“同居单身成年人”的未投保比例高达33.4%，是上一条的两倍多。

这可能是奥巴马医改补贴比起没有孩子的家庭来说更有利于单亲或双亲家庭的一个原因。医改计划的目标人群有单亲母亲，有孩子且勉强维持生活的中产阶级家庭，高消费城市中未婚、没有固定高薪工作或为单一雇主工作的创意阶层的千禧之子。

不只是医疗保险会让婚姻家庭产生罚款，联邦所得税也会让双方收入均衡的已婚夫妻比只有一方养家的夫妻损失更多。

美国传统基金会资深研究员罗伯特·芮克特说：“在免税代码中,已婚夫妻有一套不同的税率，这会使婚姻罚款减轻到一定程度。”从2010年以来，他就已经开始写有关于医疗改革中的婚姻罚款事由了。

芮克特还表示，“你所做的事情表明你不得不支付一项数以千记美元的罚款来维持婚姻，这笔钱是你收入的很大一部分。也就是说社会根本就对婚姻制度怀有敌意”。

研究婚姻罚款造成的影响方面的专家怀疑许多夫妻会考虑用离婚来改变保险费率。一些数据也表明这种政府项目所带的婚姻罚款会鼓励那些倾向不结婚又从这些项目中获利的人们。

布鲁金斯协会的高级研究员加里•贝特里斯的解释称：“财政学中公认的智慧是如果夫妻双方有体面收入的潜力，则婚姻实质上会使家庭财政状况变坏，而且会让他们面临的综合税率比没一对没结婚的更高。在低收入群体中，如果夫妻的总收入前景不乐观，婚姻或许会让母子得到的政府补贴更少。”

现在还没有数据显示平价医疗法案带来的这种顾虑可能会影响的人口数，但是加里指出医疗补助制度和其他发放救济项目“已经造成那种潜在的婚姻罚款”。至少一半新加入平价医疗保险的人也会被纳入医疗补助保险中。

诺娜说有巨大讽刺意味的是如果不是2009年时他正好需要健康险，他们就不会结婚了。

尽管有个具有行政意味的开端，他们在市政厅办理的婚姻依然持续到今日。亚伦一开始是在诺娜的保险名下，后来，他们的工作安排改变了，情况又反过来了。现在诺娜正在找个全职的员工工作，希望能有个由雇主提供的医疗保险，那么亚伦也能加入了。

她说：“我能向你保证，六个月内我要么离婚，要么找个全职工作。”