I've heard of shotgun weddings...

http://www.nytimes.com/2008/08/13/us/13marriage.html?_r=1&oref=slogin

Health Benefits Inspire Rush to Marry, or Divorce
By KEVIN SACK

LAKE CHARLES, La. — It was only last February that Brandy Brady met Ricky Huggins at a Mardi Gras ball here. By April, they had decided to marry.

Ms. Brady says she loves Mr. Huggins, but she worries they are moving too fast. She questions how well they really know each other, and wants to better understand his mood swings.

But Ms. Brady, 38, also finds much to admire in Mr. Huggins, who is three years older. He strikes her as trustworthy and caring. He has a stable job as a plumber and a two-bedroom house. And perhaps above all, said Ms. Brady, who received a kidney transplant last year, “He’s got great insurance.”

More than romance, the couple readily acknowledge, it is Mr. Huggins’s Blue Cross/Blue Shield HMO policy that is driving their rush to the altar.

In a country where insurance is out of reach for many, it is not uncommon for couples to marry, or even to divorce, at least partly so one spouse can obtain or maintain health coverage.

There is no way to know how often it happens, but lawyers and patient advocacy groups say they see cases regularly.

In a poll conducted this spring by the Kaiser Family Foundation, a health policy research group, 7 percent of adults said someone in their household had married in the past year to gain access to insurance. The foundation cautions that the number should not be taken literally, but rather as an intriguing indicator that some Americans “are making major life decisions on the basis of health care concerns.”

Stephen L. J. Hoffman, an officiant at a wedding chapel in Covington, Ky., said he was no longer shocked that one of 10 couples cite health insurance as the reason they stand before him.

“They come in and say, ‘We were going to get married anyway, but right now we really need the insurance,’ ” said Mr. Hoffman. “There may be an unplanned pregnancy, or there is an illness, or they’ve lost their job and can’t get insurance.”

Though money and matrimony have been linked since Genesis, marrying for health coverage is a more modern convention. For today’s couples, “in sickness and in health” may seem less a lover’s troth than an actuarial contract. They marry for better or worse, for richer or poorer, for co-pays and deductibles.

Bo and Dena McLain of Milford, Ohio, eloped in March so he could add her to his group policy because her nursing school required proof of insurance. Corey Marshall and Kim Wetzel, who had dated in San Francisco for four years, moved up their wedding plans by a year so she could switch to his policy after her employer raised premiums

Ms. Brady and Mr. Huggins concede that their discussions about marriage have been freighted with cost-benefit analysis.

Ms. Brady learned three years ago that she had end-stage renal disease and after two years of dialysis received the transplant in May 2007. Her medical costs remain substantial and unpredictable. The demands of dialysis forced her to give up a much-loved job as a store manager for the Body Shop, and she eventually lost her insurance.

She now receives a Social Security disability check of $1,181 a month, and spends $95 of that on premiums for Medicare, the federal health insurance program for the elderly and disabled, which insures kidney transplant patients for up to three years.

With Medicare covering only 80 percent of most charges, however, Ms. Brady still has been left with thousands of dollars in bills.

Until this spring, Ms. Brady filled the gaps with a supplemental policy bought from State Farm. In April, she received notice that the premium was more than doubling, to $2,621 a quarter, from $1,180.

“ ‘I’ve got to cancel it,’ ” Ms. Brady said she told her agent. “I’m running out of family members to pay for it.”

That is when Ms. Brady and Mr. Huggins started talking about marriage. They reasoned that if they wed, Mr. Huggins could add her at modest cost to the group policy he buys through his union. That policy, combined with Medicare, would provide full coverage.

“I told him, ‘Let’s just do it. Can we do it without family?’ ” Ms. Brady recalled. “I felt the only way I could get around this was to marry him.”

As Ms. Brady has weighed her marital doubts against her medical needs, the couple has shifted wedding dates four times, most recently to Oct. 11. Her instincts tell her to delay. But each time the bills mount, she feels pressure to act sooner rather than later.

“I love him a lot, and I want to marry him,” Ms. Brady said. “I just don’t want to be forced to marry him early for insurance purposes.”

Mr. Huggins asks only that he have enough time to invite a few family members to the ceremony.

“I know I love her,” he said, “and I know I want to spend the rest of my life with her. The reasons and how fast we do it, that’s just secondary.”

In some instances, the need for insurance may prolong unhappy marriages.

When a mammogram confirmed in April 2007 that Sherri Parish had a lump in her breast, she panicked not only because of the devastating health news, but also because she was two weeks from a court date to finalize her divorce. Across the ups and downs of a 20-year marriage, her husband, Jonathan, had insured her through his job as a construction foreman in Noblesville, Ind.

“It was a devastating time for me,” Ms. Parish said. “I wasn’t sure what was going to happen with either the prognosis or the financial side of it.”

A nurse and mother of three, Ms. Parish, 47, had had little contact with her husband since they separated a year earlier. Through lawyers, she asked Mr. Parish, 49, if he would consider a delay so she could pursue treatment. He agreed.

“He didn’t want me to be without health care coverage because I’d never had it without him,” Ms. Parish said. “He’d always been the breadwinner, and I always worked two or three days a week and raised the children.”

Other couples, like Michelle and Marion Moulton, are forced to consider divorce so that an ailing spouse can qualify for affordable insurance.

Ms. Moulton, 46, a homemaker who lives near Seattle with her husband and two children, learned three years ago that she had serious liver damage, a side effect, she believes, of drugs she was once prescribed. She is trying to get on a transplant list, but the clock is ticking; her once slender body has ballooned, and her doctors say her liver could give out at any time.

Mr. Moulton, a self-employed painting contractor, maintains a catastrophic coverage plan for his family, but its high deductibles and unpredictable reimbursements have left them $50,000 in debt. Without better coverage, a transplant could add unthinkable sums.

Two years ago, Ms. Moulton looked into buying more comprehensive coverage through the Washington State Health Insurance Pool, a state-financed program for high-risk patients. She found the premiums unaffordable, but noticed that the state offered subsidies to those with low incomes. As their debts and desperation multiplied, it occurred to Ms. Moulton that divorcing her husband of 17 years would make her eligible for the subsidized coverage.

“I felt like I had done this to us,” she said. “We had worked hard our entire lives, and if this was all the insurance we had, we could become homeless. I just said, ‘You know, we really need to sit down and talk about divorce.’ ”

Mr. Moulton would not consider it — at first. “From a male point of view, you want to be able to fix things, you want to be able to provide,” he said.

“Then you start looking at what things cost and what someone with no assets can get in terms of funding, and you have to start thinking about it.”

The conversations ebbed and flowed with the family’s financial pressures. They talked about the effect on their children and where they might live. They weighed the legal and financial risks against the prospects of bankruptcy.

The debate continued until this summer, when Mr. Moulton’s father offered financial help. “I know we don’t take charity from anyone,” Mr. Moulton told his wife, “but I’m not going to divorce you and I’m not going to let you die.”

Though grateful for the lifeline, the couple remains unsettled by how close they came.

“Nobody should have to make a choice like that,” Ms. Moulton said. “What happened to our country? I don’t remember growing up like this.”