By Nicky Grist

For our grandparents, a “shotgun wedding” meant you had fooled around and got (or got someone) pregnant. Now, it means you care about someone enough to put him or her on your health insurance.

Back in the spring of 2008, the breaking news was that 7% of registered voters said someone in their household decided to get married mainly to have access to health care benefits, according to a Kaiser Family Foundation poll. AtMP’s press release in response to this poll said “Perhaps policy-makers will start to recognize what the public already knows: marriage is the on / off switch for access to health care in America.”

In December 2008, I wondered if my wishes were coming true: the National Center for Health Statistics (a branch of the U.S. Department of Health & Human Services), announced “Marriage affects health insurance coverage.” In particular, it reported that “Overall, unmarried (divorced or never married) women aged 25–64 years are more likely to be uninsured (21%) than married women (13%) in the same age group. Poor married women are more likely to be uninsured than poor unmarried women, in part because they are less likely to have Medicaid coverage.”

So I started wondering: How many shotgun wedding stories and government research reports do policy-makers have to read before they propose truly universal health reforms that don't discriminate on the basis of marital or relationship status?

Now that we’re in the spring of 2009, I’m feeling cautiously hopeful. Several new laws have been proposed that would give unmarried partners access to health care at close to the same level as spouses. Here are a few examples that AtMP is tracking:

On health insurance – the Senate Finance Committee (which is taking the lead on reform efforts) uses the following family composition descriptions in its approach to expanding health care coverage: single, adult with child, family, or two adults. When the Committee invited public comment, AtMP submitted a detailed analysis recommending (among many other things) that insurers who cover any two adults should be required to cover all two-adult families, without specifying the nature of the relationship between the parties.

Meanwhile, the Domestic Partners Benefits and Obligations Act is waiting to be re-introduced in Congress. The 2007 version proposed to let federal employees include domestic partners on their health insurance and other job-related benefits. This bill defined a domestic partner as “an adult unmarried person living with another adult unmarried person of the same sex in a committed, intimate relationship.” AtMP wants to see a more inclusive definition of domestic partners in the new version.

On family leave – the Family and Medical Leave Inclusion Act of 2009 proposes to require large employers to give full-time workers time off to care for a same-sex spouse, domestic partner, parent-in-law, adult child, sibling, or grandparent who has a serious health condition. The Family Leave Insurance Act of 2009 would make that paid leave. We’re glad to see that these bills go beyond conjugal relationships, and that they define domestic partners broadly. DPs can be any couple who has registered with their state or locality (many localities register both same- and different-sex couples, and a few localities register non-romantic couples such as siblings), plus same-sex spouses and same-sex couples who live in places that don’t have DP registries. This is a big improvement, though it still leaves out different-sex couples who live in places where they can’t register.

On hospital rights - New York State lawmakers have introduced a bill about medical decision-making that treats domestic partners the same as spouses. (For this law, DPs don’t have to be formally registered; they could be beneficiaries on each other’s employment benefits or health insurance, rent or own property together, have children together, etc.) New York gave DPs equal hospital visitation rights a few years ago.

AtMP is lobbying in support of the New York medical decision-making law for two reasons: first, it’s a good idea; second, it gives us an opportunity to challenge the myth that New Yorkers get hospital rights when they get married. The truth is that unmarried people have equal visitation rights, and no one currently has the right to make medical decisions for incapacitated patients in the absence of advance directives.

To learn more about these and other health care reforms, and to add your voice to AtMP’s calls for equal access to health care for all unmarried people, send us a note or call 718-788-1911. If you’re too busy or too shy to be an activist, please help us cover the costs of advocacy by making a tax-deductible donation. Thank you!

Nicky Grist is Executive Director of the Alternatives to Marriage Project.