DOMA and the ACA

Wonkblog's Sarah Kliff and others have begun to consider whether it is necessarily in a gay couple's best financial interest, under the ACA, to be married. She posts that individuals who may qualify for premium supports and subsidies through the exchanges or even expanded Medicaid eligibility may combine their incomes into a household where neither spouse is entitled to such subsidies or expanded Medicaid eligibility.  Without ever acknowledging that these same marital disincentives may also exist for heterosexual couples — the way the federal tax code systematically punishes two relatively high wage earner marital households springs to mind — she talks about assessing the "financial interest" of a gay couple.

I do think that same sex couples contemplating marriage will have some serious financial and estate planning considerations to address,  but they should extend far beyond the immediate concern of health care premium supports under the ACA and extend all the way to Medicare eligibility.  The financial implications of marriage — in theory (and for significant demographic cohorts — in reality)  a lifetime commitment  — actually merit both a short term analysis and a long term analysis.

A short term analysis might look at eligibility for family based coverage under a spouse's employer sponsored health insurance plan.  This is a good time to remember that employers are not required to offer family coverage under the ACA.  A private employer may meet its play or pay obligation, in short, by offering individual coverage under an employer sponsored commercial plan.  A spouse of any gender would then be pushed to the exchanges, Medicaid, or their own employer's insurance plan. If the spouse's employer also offers only individual coverage, then any children of the household will be pushed to Medicaid, Medicaid extension programs, or the exchanges themselves.

Mind bogglingly complex to contemplate each member of a single household enrolled in a different insurance plan? Yes. A concern peculiar to same sex couples contemplating marriage? No.

A longer term analysis might look at social security eligibility and its handmaiden, Medicare eligibility. Depending upon how a family organizes its wage income production, a spouse may qualify for a more generous benefit under the breadwinner's work record than under their own, particularly if labor force attachment has been attenuated by family or other responsibilities.  But you don't get to claim social security retirement under the employment record of a spouse of an extremely brief marriage.

Remaining unmarried to qualify for ACA premium support while planning to marry in the future for spousal social security benefits and Medicare eligibility, in short, may be inconsistent approaches. At the very least, questions of timing must be considered.

Yes, affordable health insurance coverage matters here and now beyond words. Medicare coverage during your peak health care consuming years matters too, for most Americans.

Each couple will need to do the math for themselves with so many individually relevant variables in the mix: work record, ages at marriage, anticipated retirement ages, likely income trajectories. But it won't be as simple, for many, as determining how best to attain premium supports under the ACA or to attain expanded Medicaid eligibility — as pressing as those needs are for many.