奧巴馬醫改對婚姻的隱性懲罰

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 2012 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 2012 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 2012, 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.無子女夫婦和空巢老人支付“罰款”更多，而且多得多。

第一次聽到諾娜·威利斯·阿羅諾維茨談起要離婚來爲健康險存錢時，我想她一定是在開玩笑。那時是六月下旬，我們正和一羣紐約女作家在蒙特吃晚餐，那裏位於南布魯克林區的一個意式地方。

我當然勸她千萬別這麼做。這些年來我也曾目睹我的朋友們經歷離婚。不管她或是她的丈夫覺得這張宣告他們結婚的紙張其實不重要，他們之間的關係都會隨着離婚而不可避免地產生很大變化，就像當初他們結婚時一樣。

然而隨着平價醫保法案保險交易的實行，諾娜和她的丈夫亞倫·卡薩拉麪臨的問題從休閒的談話境界轉移到一個真正的金融困境。他們今年分別是29歲和32歲，住在一個極度昂貴的城市又遇到了工作上的艱難時刻，更可怕的是他們的保險即將到期。諾娜告訴我她現在只有一個到一月一號停止的統一預算協調法案規定的健康險，但她也幾乎無法負擔了。她的上一份員工工作結束了，因爲媒體透露她在爲一整支解僱了的編輯團隊而工作。之後她就成了一名專職自由作家。亞倫是一名兼職電影製片人同時也是一位自由作家，自從妻子失業後，他就已經不投保了，因爲那太昂貴了。

如果任何一個兩口之家的夫妻收入超過聯邦貧困線四倍即62040美元，根據奧巴馬醫改他們將得到很多補貼。凱薩家庭基金會的醫療保健市場項目負責人，加里·克拉克斯頓表示“如果你的收入在貧困線四倍以上，那麼你就不符合高級支持的條件”。

反之如果同樣的一對兒住在一起但不結婚，他們每人可以掙到45960美元，加起來也就是91920美元，但他們仍然有資格通過紐約州的保險交易獲得補貼。要知道這裏的保險相對來說很昂貴,而且這個州的交易建立在不給年輕人提供更低利率的方式上。（補貼資格的計算用了一種很複雜的方法，涉及到收入水平與貧困線和家庭人數的比較，並且補貼通過這個州的市場發放。）

諾娜和亞倫2012年的收入略高於四倍線。在紐約，這樣的收入水平仍然無法讓兩個人過得很好。根據凱薩家庭基金會和電子健康補貼的計算顯示，如果他們最近幾個月的收入在還同樣的範圍內，那對他們申請補貼毫無幫助。兩個人爲白銀級別的保險一年要支付9248美元。

但如果他們以未婚的個人身份和一些別的條件類似於2012年收入來申請的話，一個人就能得到至少3964美元的購買保險的補貼，或者甚至有可能有資格申請醫療補助，這都得歸功於這一年時好時壞的個人收入。若是他們的收入不足四倍線，諾娜說今年就有可能，那倆人能獲得大量的津貼，當然作爲個體申請依然比用夫妻身份申請得到補助的多。這些差距是對婚姻家庭的罰款。

未投保的人中已婚的只佔一小部分，理由顯而易見：如果你有兩條可行的路可走，投保會更容易。據凱薩家庭基金會的調查顯示，2012年已婚人士中只有15.4%未投保；“同居單身成年人”的未投保比例高達33.4%，是上一條的兩倍多。

這可能是奧巴馬醫改補貼比起沒有孩子的家庭來說更有利於單親或雙親家庭的一個原因。醫改計劃的目標人羣有單親母親，有孩子且勉強維持生活的中產階級家庭，高消費城市中未婚、沒有固定高薪工作或爲單一僱主工作的創意階層的千禧之子。

不只是醫療保險會讓婚姻家庭產生罰款，聯邦所得稅也會讓雙方收入均衡的已婚夫妻比只有一方養家的夫妻損失更多。

美國傳統基金會資深研究員羅伯特·芮克特說：“在免稅代碼中,已婚夫妻有一套不同的稅率，這會使婚姻罰款減輕到一定程度。”從2010年以來，他就已經開始寫有關於醫療改革中的婚姻罰款事由了。

芮克特還表示，“你所做的事情表明你不得不支付一項數以千記美元的罰款來維持婚姻，這筆錢是你收入的很大一部分。也就是說社會根本就對婚姻制度懷有敵意”。

研究婚姻罰款造成的影響方面的專家懷疑許多夫妻會考慮用離婚來改變保險費率。一些數據也表明這種政府項目所帶的婚姻罰款會鼓勵那些傾向不結婚又從這些項目中獲利的人們。

布魯金斯協會的高級研究員加里•貝特里斯的解釋稱：“財政學中公認的智慧是如果夫妻雙方有體面收入的潛力，則婚姻實質上會使家庭財政狀況變壞，而且會讓他們面臨的綜合稅率比沒一對沒結婚的更高。在低收入羣體中，如果夫妻的總收入前景不樂觀，婚姻或許會讓母子得到的政府補貼更少。”

現在還沒有數據顯示平價醫療法案帶來的這種顧慮可能會影響的人口數，但是加里指出醫療補助制度和其他發放救濟項目“已經造成那種潛在的婚姻罰款”。至少一半新加入平價醫療保險的人也會被納入醫療補助保險中。

諾娜說有巨大諷刺意味的是如果不是2009年時他正好需要健康險，他們就不會結婚了。

儘管有個具有行政意味的開端，他們在市政廳辦理的婚姻依然持續到今日。亞倫一開始是在諾娜的保險名下，後來，他們的工作安排改變了，情況又反過來了。現在諾娜正在找個全職的員工工作，希望能有個由僱主提供的醫療保險，那麼亞倫也能加入了。

她說：“我能向你保證，六個月內我要麼離婚，要麼找個全職工作。”