Did ACA re­peal fail­ure save lives … and love?

Modern Healthcare - - OUTLIERS ASIDES & INSIDES -

The re­cent im­plo­sion of the House GOP’s re­place­ment plan for the Af­ford­able Care Act may have done more than save Med­i­caid cov­er­age for mil­lions. A num­ber of mar­riages could also have been pre­served in ex­pan­sion states.

A re­cent anal­y­sis con­ducted by eco­nom­ics re­searchers at the Univer­sity of Kansas com­pared di­vorce rates in 40 states— half of which ex­panded Med­i­caid in 2010 for all adults mak­ing up to 138% of the fed­eral poverty level and half of which never adopted ex­pan­sion.

The anal­y­sis found a 5.6% de­crease in di­vorces among cou­ples age 50 to 64 in Med­i­caid ex­pan­sion states com­pared with non-ex­pan­sion states.

Un­der the ACA’s Med­i­caid ex­pan­sion, rules were changed to base el­i­gi­bil­ity on the level of the cou­ple’s net in­come and elim­i­nate max­i­mum as­set qual­i­fi­ca­tions.

Ac­cord­ing to study co-au­thor David Slusky, as­sis­tant pro­fes­sor of eco­nom­ics at the Univer­sity of Kansas, the change in Med­i­caid rules likely re­duced the need for “med­i­cal di­vorce.” Such cases oc­cur when one part­ner ex­pe­ri­ences a de­bil­i­tat­ing health con­di­tion, and the cou­ple de­cides to di­vorce so the other part­ner can re­tain their as­sets while the per­son who is sick files for Med­i­caid.

“From th­ese re­sults, I would ex­pect fu­ture states that ex­panded Med­i­caid would see rel­a­tive drops in di­vorce,” Slusky said. “We talk a lot in this coun­try about the other half of this, meaning strate­gic mar­riage when it comes to im­mi­gra­tion or gain­ing health in­sur­ance from one’s em­ployer,” Slusky said. “But we don’t talk about the other side—the con­se­quence of ty­ing so many things to be­ing mar­ried is that you can cre­ate ad­verse in­cen­tives on both sides.”

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