Divorce doesn't just lead to broken hearts and households—it has a tremendous impact on women's health: Each year, an estimated 115,000 women lose private health insurance in the months following divorce, and about 65,000 of them remain uninsured for the long-term, according to a new analysis. The study, which appeared in the Journal of Health and Social Behavior, found a stunningly high cost to divorce for women's health. Even two years following the breakup of a marriage, many women still have no or inadequate health insurance.
The new research adds "to the body of evidence that the current health care and insurance system in the United States is inadequate for a population in which multiple family and job changes over the life course are not uncommon," the authors wrote. "As a result, life events such as job transitions, marital transitions, and the onset of health problems allow individuals to slip through the cracks." The authors looked at marital status and health insurance coverage over time among 1,442 women to examine how their health insurance changed after divorce.
Previous research has demonstrated that people often experience poorer health following divorce and that women are more likely than men to suffer a decline in economic status after divorce. The new study is one of the first to show the impact of marital breakups on health insurance coverage.
"Just over half of workers get employer-based coverage, and a lot of people access health insurance coverage through other people's employer-based coverage," Bridget Lavelle, a co-author of the paper and doctoral candidate in public policy and sociology at the University of Michigan-Ann Arbor, told TakePart. "One in four women are insured through a family member's health insurance coverage. It's important for people to be aware that this is something that could be lost if a marriage dissolves."
Some of the women who lose health insurance coverage following divorce are employed. But they may not have employer-based coverage or, prior to the divorce, they may have chosen to access their spouse's plan rather than their own. "Women who are employed and are offered employment-based coverage have a higher rate of declining that coverage and accepting coverage through their husband's policy," Lavelle says. "They are expecting their husband's coverage to be more comprehensive or be a better value."
While some women are able to switch to their own employer's health insurance plan following divorce, a surprising number lose coverage or go on Medicaid, the government's insurance program for the poor. Six months after divorce, 10.3 percent of women in the study who experienced divorce had Medicaid coverage, compared to 5.6 percent prior to divorce.
"One of the things we did find is women who have full-time, stable jobs before divorce and received health insurance through their jobs were largely protected from health insurance loss," following the end of a marriage, Lavelle says. "But even some of them still lost coverage. They may have difficulty continuing to pay their share of the employer-health insurance premiums." Middle-income women tend to be hardest hit following divorce because they can't qualify for Medicaid, she added.
Insurance loss may compound the economic losses women experience after divorce and contribute to declining health following a breakup. "We know losing health insurance can cause a lot of stress. People tend to worry about getting sick. Women without health insurance are less likely to go to the doctor for checkups or are less likely to get care when they're sick.
"One of the reasons we started looking at this topic is because women tend to experience major economic losses after divorce—major losses of income, increases in poverty, decreases in wealth," she adds. "That is well understood from the research side and in the public view. But health insurance isn't something that the public necessarily thinks about in terms of how is my marriage giving me access to this resource."
Given the rapid increase in the cost of health insurance over the past decade, more couples may be discussing health insurance as part of divorce settlement negotiations. "I have heard that asking or requiring one spouse to continue paying for health insurance can be a part of a divorce settlement," Lavelle says. "Some people separate rather than divorce in order to maintain health insurance coverage."
The passage of the Affordable Care Act could help some women obtain adequate health insurance coverage following divorce. Although the full impact of the law won't be clear for several more years, people who are not covered by employer-based insurance should have expanded access to affordable insurance through the private market exchanges and expanded access to Medicaid. Even under healthcare reform, America's healthcare insurance system will remain a patchwork of plans with too little security, the authors said.
The current study looked at the impact of women because more married women are covered under their spouse's health insurance than vice versa. But future studies should examine what happens to men following divorce who were covered by their wives' insurance, the authors said.
Should couples address health insurance coverage as part of divorce settlement negotiations? How might women better protect themselves from the loss of coverage?
Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.