Singles and Healthcare

by Sarah on July 2, 2014

Since my social media feeds are blowing up with comments about the shit-tastic SCOTUS ruling (and Ruth Bader Ginsberg’s rockin’ dissent) I thought I’d take a moment to talk about singles and how our relationship to healthcare is different and more challenging than coupled folks, and why this decision is extra-frightening for single people in particular.

At its most fundamental, single folks have fewer healthcare choices. We either get insurance through the state if we meet the income qualifications, privately through an insurance company of our choice (which may or may not be an available option to us depending on whether our company offers insurance), or through our employer. Married people have one additional option: through their spouse’s employer.

In light of employers’ religious views now being allowed to influence the health coverage they’re willing to pay for, it is nice to have that extra option. It also makes it possible for people who are unemployed to still have quality health coverage at affordable rates. I know a lot of couples who take advantage of this while one person goes back to school or starts a business or raises kids or just takes some time off.

None of those are options for a single person.

While I was traveling, I was paying close to $200/month for a shitty high deductible plan that would only cover urgent care out-of-state. That’s an expensive emergency plan. (Note: This is pre-ACA. Although when I priced out a comparable plan through the exchanges in NY earlier this year, it looked about the same. I suspect, however, that NY is also one of the more expensive states in which to get insurance.)

Of course, for me, the idea of having a husband or wife back home working to keep me in health insurance sounds a lot more painful than $200, so I’ll take it, but it doesn’t make the inequality any less problematic. I’m grateful that I have largely been able to keep myself insured despite being not being conventionally employed for about 75% of my adult life. But then, this isn’t about me, it’s about a system which is unfair and problematic.

Talking about things which are unfair, single people often get to witness their company shell out twice as much (or more) on health insurance for their married employees. I know my company pays a higher premium for my married colleague, his wife, and his kids than for me. And yet, they don’t look at me and say, “Oh, you get the same $600 health allotment as so-and-so. For you, that covers your entire premium!” Nope. I get 50% same as everyone else. It’s just that my 50% is a lot smaller than that colleague’s. (Admittedly, the 50% he pays is a lot bigger too, but that’s his choice.)

At heart, my fundamental problem with health insurance is two-fold.

1) The basic unit of healthcare is a nuclear family, not an individual.

Sure, groups have better purchasing power than individuals. This is generally true across the board.

But who the fuck gets to decide that the only valid group I’m a part of for health insurance purchasing is a family?

Furthermore, who the fuck gets to decide that once a person is past their twenties, they no longer are considered part of their family of origin for healthcare purposes. Now that I’m in my 30s, it’s a spouse and children only, or bust.

Anyone notice enforcement of normative relationship and family models sneakily hiding in our healthcare system?

Yeah, me too.

2) Healthcare comes primarily from corporations.

We are largely expected to get our healthcare through our jobs. In fact, I know people who literally only work so they can have healthcare. It’s one of the major explanations I hear from people when they try to explain to me why they have to be employed.

(Side note: When I quit my job and traveled, a lot of people felt the need to tell me why they couldn’t do the same. I don’t go around trying to convince people that they don’t need jobs. Although, now that I mention it, it doesn’t sound like a bad life path.)

Anyway, healthcare coming from our employers definitely seems to enforce some puritanical work ethic bullshit. The basic idea is that one needs to be employed for one’s entire life (unless one has a spouse) because it’s the only way to access affordable, quality healthcare. Normative, normative, normative. It’s like a little healthcare prison, designed to keep us working our entire lives because anything else would be just too risky.

This isn’t why the system exists the way it does, admittedly, but it doesn’t make it any less onerous.

Recently, I had a small health scare. It turned out to be nothing, but as I was considering all the possibilities, I had to keep returning to the fact that in order to continue receiving good health coverage at a reasonable price, I need to stay employed. If I ever was sick to the point I couldn’t work, I don’t have a spouse or a parent’s health insurance plan to fall back on. And if I suddenly became unemployed, I wouldn’t immediately be eligible for state coverage, nor would I necessarily be able to afford the expensive COBRA premiums without a job.

Helloooooo clusterfuck.

So, what’s the answer?

I have no clue.

Universal health care? A single payer system? Framily plans?

I don’t know the answer although I know there is a lot of great information out there on the benefits of unlinking healthcare from employment and more about single payer options.

And I also know that the situation we have now is shit-tastically bad, and twice over for single folks.

{ 3 comments… read them below or add one }

Lisa September 29, 2014 at 8:02 pm

Holy crap. I’ve never thought about “what would happen if you got sick enough that you couldn’t work, and then couldn’t have health insurance.” I’d have LTD insurance for a bit, but that would run out. Then I wouldn’t be able to afford any insurance.. Social Security then? Hmm… good point on that one.


Sarah July 4, 2014 at 4:29 pm

Great post, Sarah. I agree that many of the stressors of being single relate to practical concerns like finances, yet it can still be tough to speak about these issues without coming across as complaining, but you do so effectively here. Nice job!


Sarah July 16, 2014 at 12:41 pm

Thanks, Sarah! Cheers!


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