Health Insurance Coverage and Marriage Behavior: Is There Evidence of Marriage-Lock?

Subsidies, taxes, premiums, and eligibility for health insurance can potentially cause “marriage lock,” in which couples stay married for the sake of health insurance coverage. In addition, marriage lock may change as health insurance exchanges increase health insurance options under the Affordable Care Act. In this paper, marriage lock is examined under two key insurance decisions: divorce decisions due to qualification for Medicare at age 65, and marriage and divorce decisions caused by the introduction of the Massachusetts insurance mandate and health insurance exchange market under the 2006 healthcare reform. Using the Health and Retirement Study for adults aged 60–70, I first examine whether employer-based health insurance coverage for the spouse discourages divorce for spousal health insurance coverage-dependent individuals by reviewing the discontinuity created at age 65 through qualification for Medicare. Diverse difference-in-difference models provide evidence of a 7 percent larger positive effect of Medicare eligibility on late life divorce for people with spousal insurance coverage dependence than for those without it. Next, using American Community Survey data, I examine how marriage behavior changed when the health insurance exchange market and individual mandate were introduced to Massachusetts in 2006 relative to control states. I find that the 2006 Massachusetts healthcare reform increased incentives for marriage in the health insurance exchanges market. Specifically, the Massachusetts reform appears to have reduced the divorce rates by approximately 0.5 percent and increased marriage rates by approximately 1.4 percent. My estimates in the paper provide some evidence that “marriage lock” exists and further suggest that health insurance coverage could serve as a marriage lock and the price of health insurance also plays an important role.