"...Until universal health care exists." This design (drawn for AtMP by New Yorker cartoonist Paul Karasik).

What does marital status have to do with health care? Many unmarried individuals in a relationship cannot receive health care benefits through a partner's plan because of their marital status, even with a rise of coverage available due to recognition of domestic partnerships. People in different-sex and same-sex coupled relationships are often denied access to their partner's health care benefits if they are not married. When people are unmarried for either personal, political, or legal reasons, they may suffer because of it. Others are financially coerced into marriage in order to gain access to benefits such as health insurance. A part of the answer to America's health insurance woes is to delink marital status—and therefore employment—from access to health care.

According to the National Coalition on Health Care (NCHC), 46 million Americans were without health insurance in 2004 and the percentage of people with employment based health insurance has dropped from 70% in 1987 to 59.8% in 2004. This is the lowest level of employment based insurance coverage in more than a decade. Even if companies offer health care benefits, employees cannot always afford to contribute to coverage for themselves and additional premiums for families. Employee's contributions to health insurance coverage increased 143% between 2000 and 2005.

AtMP often hears about health care issues from people who visit our website. Here are two common examples of such dilemmas. Linda, from Michigan, writes about the limitations of domestic partnership coverage in her state:

Health insurance [and] life insurance is available through my work for same sex partners but not different sex partners. I also have family sick time which does not include my partner.

On the issue of marrying in order to get health insurance coverage, Tasia explains:

I got married to my business and life partner Brian on March 14th. I did it for purely financial reasons—Dental and Health Insurance! Brian and I went to the dentist today. Do you have any idea how impossible it is to get Dental Insurance when you are self-employed? I have not told my family we are married. We have not told his family. Strictly speaking, our getting that piece of paper made no difference in our relationship, what so ever.

The recognition of domestic partnerships in some regions of the country and by some businesses currently functions as a stop-gap measure in the absence of universal health care, providing the extension of benefits for many people. Opponents of domestic partnerships claim that providing benefits to unmarried couples is immoral and costly. Earlier this year, the state-sponsored University of Louisville in Kentucky began offering health insurance for domestic partners in order to improve their benefits package and attract new talent. Professor of Engineering Gina Bertocci is an example of a new faculty member recruited to Louisville with the understanding that she would be able to cover her partner under her health insurance plan. Senator Richard Roeding and the Family Foundation of Kentucky objected to the expanded coverage. Senator Roeding explained, "I don't want to entice any of those people into our state. Those are the wrong kind of people." Dave Edmunds, a policy analyst for the Family Foundation of Kentucky, characterized the program as a rejection of traditional marriage and that taxpayers should hold lawmakers accountable for the university's decision to fund the program. In response, University Trustee Bill Stone argued: "From an economic development position this does send [a message] to the rest of the country that this is an enlightened institution."

Issues of taxation and so-called family values are intertwined around objections to extending benefits to domestic partners. While opponents of domestic partnership claim that it places an improper burden on taxpayers, that's factually inaccurate. Not only would extending benefits to domestic partners cost about the same as extending benefits to married couples, it could actually end up saving taxpayers money. If domestic partners are able to rely on each other more, it would reduce current reliance on state and federal assistance. Studies have projected that the California would save an estimated $8.1 to $10.6 million each year by enacting the most comprehensive domestic partner law in the nation. In New Jersey, which passed a new domestic partner law in 2004, the savings were projected even higher – more than $61 million each year. Additionally, under current federal law, a domestic partner's health insurance premium is taxed as part of the employee's income. Married couples, not subject to such a tax, receive special treatment from the federal government in this regard.

In Benitez vs. North Coast Women's Care Medical Group, the plaintiff sued her doctors for refusing to continue with infertility treatment because she was a lesbian. The doctors claim their refusal was based on Benitez's unmarried status, not because she's a lesbian, and that they have a right to make this decision on religious grounds. The ruling has twice gone in favor of the doctors and is currently under review of the Supreme Court of California. Joel Ginsberg, Executive director of the Gay and Lesbian Medical Association, said, "Health care providers in California need to know that discriminating based on sexual orientation or marital status, even if for religious reasons, is unethical and illegal."

More organizations working on health care reform should follow Ginsberg's example and, in their advocacy, point to marital status discrimination as a significant factor in health care debates. The recognition of domestic partnerships has been an important step in providing access to health insurance many people who would currently be without coverage. Ultimately, a fairer strategy that would support freedom and diversity would be a state-sponsored health care system that does not deliver health insurance through employment, but to all people regardless of family status.

Ryan McKelvey attends Hunter College where he studies Political Science. This summer he researched unmarried people's access to health insurance, under the guidance of AtMP board member Jennifer Gaboury.