Employment-based Health Insurance

Unmarried Equality believes that access to employer based health insurance in the United States should not be determined by relationship or marital status. Although we applaud efforts by some businesses to make health insurance more accessible (by offering domestic partnership benefits, for example), we believe further steps must be taken to ensure that marital status is not a barrier to health care.

Problem: The Current System Discriminates

The health care system in the United States distributes insurance unevenly and unfairly. Unmarried people are disproportionately uninsured. Marital status discrimination is built into the current system because it relies on employer-based health insurance. In addition to the obvious financial barriers, access to health insurance is limited by federal laws regulating employer based insurance, the federal government’s definition of family and a number of state laws regarding employer based insurance.

The Employee Retirement Income Security Act (ERISA) prevent states from directly requiring employers to provide health insurance to employees and their families. This allows employers to choose whom they want to cover, which in turn gives employers the power to define what constitutes family. Consequently, employers often use martial status as the sole determinant of whether someone will receive employer-based insurance through a partner.

The Defense of Marriage Act (DoMA) strips unmarried families of the rights and privileges afforded to their married counterparts. DoMA defines marriage as solely between one woman and one man and “spouse” as an opposite sex husband or wife. Job-based benefits for spouses and dependents are not taxed as income but, because DoMA defines “spouse” so narrowly, unmarried partners are required to pay taxes on whatever employer benefits they receive. The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides employees and “qualified beneficiaires” continued insurance coverage after loss of employment, divorce or the death of an employee. Since “spouse” only applies to an opposite sex husband or wife, all unmarried partners, regardless of whether or not they were previously covered, are not entitled to continued coverage under COBRA.


Ideally, basic health care and costs should be equal for all individuals under a national single-payer system. Short of this solution, there are many incremental ways to increase the efficacy of non-marital caring relationships. None are radical; each is already in use somewhere in the United States. Our interim solutions are based on three simple principles:

  • Cover More Relationships
  • Treat Covered Relationships Equally
  • Maintain Coverage When Relationships Change