Association for Public Policy Analysis & Management

Marital decision-making is affected by policies that impact the costs and benefits of marriage. Access to health insurance through dependent coverage is a benefit of marriage that a substantial part of the population avails of. However, policies that change the eligibility criteria and costs of alternative sources of insurance can affect marital decisions. If such policies provide an alternative source of coverage than marriage, it can lead to substituting away from marriage towards lower cost and more affordable insurance. On the other hand, if such policies remove any barriers to marriage that had previously made marriage costly, we can expect a greater likelihood of transitioning into marriage.

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a gamut of new provisions that took effect in 2014. In doing so, it provided access to health insurance to many previously uninsured people as well as lower cost options to certain groups of people.

In this paper, I study the causal impact of the ACA 2014 Medicaid expansion on the propensity to marry and divorce. By doing so, I also try to address the possibility of the incidence of “marriage-lock” whereby individuals decide to marry or stay married for availing dependent coverage through their spouse’s health insurance. I use data from the American Community Survey and employ a difference-in-differences identification strategy to identify the impact of the ACA Medicaid expansion on individual’s propensity to marry or divorce. I use variation across time and state Medicaid expansion status.

The results indicate that in the relevant sample, there is a reduction in the likelihood of being newly married. The results are particularly driven by women who show a 11.6% reduction in the likelihood of being newly married. The results on divorces albeit showing an increase are not robust. However, the results for marriages support the proposition that Medicaid serves as an alternative source of coverage in place of dependent coverage, available to the sample under study. The results are stronger for women thereby validating the vulnerability of this population in losing insurance due to marriage dissolution providing indirect support for “marriage-lock”