Divorce raises risk women will be left without health coverage

A study quantifies the high number of women left without insurance after their marriages dissolve.

By — Posted Dec. 11, 2012

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A University of Michigan study has found that about 115,000 American women lose private health insurance every year as a result of divorce, and their insurance coverage remains depressed for at least two years, a phenomenon physicians and practice managers believe can manifest itself in a drop in collections and patient traffic.

Divorce is one factor contributing to declining bottom lines at medical practices, said Audrey Coaxum, a faculty member with the Practice Management Institute, a San Antonio-based provider of continuing education for medical office professionals.

“Unemployment and underemployment are also having an effect,” she said.

Some 65,000 divorced women join the ranks of the long-term uninsured, which may compound the economic losses they experience after divorce and contribute to declining health, according to the study published online Nov. 12 in the Journal of Health and Social Behavior (link).

The survey used a monthly calendar of marital status and health insurance coverage from 1,442 women in the U.S. Census Bureau’s Survey of Income and Program Participation, said Bridget Lavelle, a University of Michigan doctoral candidate in public policy and sociology and lead author of the study.

She and co-author Pamela Smock, a University of Michigan professor of sociology and women’s studies, used data on women ages 26 to 64 from 1996 to 2007, the last year in which information was available.

“We looked at different characteristics of women and found those with the highest risk are those who are covered through their husband’s employer,” Lavelle said. “One in four became uninsured.”

Also hit hard were middle-income women, who earn between 200% and 300% of the federal poverty level. “They make too much money for public insurance or Medicaid and not enough to be able to afford COBRA or buy their own insurance,” Lavelle said.

Nancy Clements, a spokeswoman for the Practice Management Institute, said divorced women may stop seeing their regular physician because they believe they will be treated differently if they are on Medicaid or a state insurance plan. Others will cancel needed treatments because they don’t have the money to pay out of pocket or even the co-payment.

Coaxum said some practices she has worked with reached out to their long-term patients who suddenly stopped coming to the office. But it is hard to know why someone doesn’t make an appointment in the first place, she said.

“We’re asking: Is it customer service? Is it another problem? If it’s financial, many practices are offering alternatives such as discounts and payment plans. Some patients are taking advantage of them; others are saying they can’t even pay that amount,” Coaxum said.

Aaron Michelfelder, MD, a professor of family medicine at Loyola University Health System in Maywood, Ill., said he has seen the opposite of what the study found. Several patients are staying in unhappy marriages to keep their health insurance coverage. In each case, one spouse has a chronic illness. In some cases, the husband would risk losing his health insurance in the event of a divorce. u

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