For most of her 16-year-old son’s life, Emily* was an unmarried mother, though for some of those years they lived with her boyfriend. That relationship ended, in part, because he didn’t want to get married, and Emily thought “it wasn’t right” to go on living together. After that, Emily decided that she was “not looking for anything or anyone.”
But as the story so often goes, that’s when she met Nick, working at the same warehouse where she had been employed for years. Emily noticed how he would pause his own work to go help someone else and stay late if work needed to get done.
“I noticed how caring he was. He’s a very selfless person,” she shared. “Even today, he doesn’t have medical insurance and he has kidney and stomach problems. But he won’t go to the doctor unless he knows that we’ve paid all our bills, and I’ve been to all my doctor appointments.”
They became friends, bonding over the many life goals they had in common and marveling at their similar mindsets. “We both like our Bible and faith YouTube videos,” Emily said. “We both pray. We like to ask questions, do research, and discuss questions about God.” Goals included basics like “have a running car” and “somehow someday own a home.”
“Get stable,” is how Emily summed it up. From the get-go, they both knew they wanted marriage, not just to live with someone. “Marriage means a lot to the both of us,” Emily told me, citing their shared Christian faith as a major factor.
But the decision to marry was fraught with “a lot of worries” about financial stability. As an unmarried mother, Emily relied on SNAP benefits and Medicaid, in part because her $13.36 per hour income didn’t cover enough to pay rent and the other bills, and because insurance through her employer was prohibitively expensive. But getting married would mean that “the benefits we received [were] on the line.” Emily calculated that their joint income would put them just above the income eligibility threshold for Medicaid.
The federal government has largely eliminated marriage penalties in the tax code that affected affluent families but has yet to address marriage penalties in safety net programs that affect working-class Americans. Couples with annual incomes between about $28,000 and $55,000 are hardest hit by these penalties, which can amount to between 10% and 30% of household income for affected families.
Where I live in southwestern Ohio, it’s not uncommon to hear people bemoan the benefits cliffs in means-tested programs. I’ve heard couples half-seriously entertain the possibility of divorce-on-paper-only in order to get more government support. I’ve attended a wedding for a couple that wanted to marry in the eyes of God but chose not to get a marriage license because the wife had Type 1 diabetes and insulin would have been unaffordable for her without Medicaid. Another woman I know, Casey, was a single mother living in income-based housing who delayed marriage because she and her fiancé worried about steep increases in rent. They did eventually marry, and the deciding factor was faith:
“My relationship with Jesus was the final reason [we got married],” Casey told me. “I was done living in sin.”
What makes people like Casey most indignant is that they feel trapped by incentives that set them up against their own ideals of marriage, faith, hard work, and the desire to eventually be self-sufficient.
Emily experienced this conflict. Insurance was crucial for her son who had regular appointments to manage medication for high blood pressure and anxiety. It was also crucial for Emily, because as an essential worker during the pandemic, she contracted Covid early on and now suffers from related congestive heart failure. Potentially losing Medicaid “was a huge risk and very worrisome,” said Emily, particularly because “we weren’t financially stable” even with the help of benefits. It was frustrating to know that “if we lived together and did not marry, I would not have as much to worry about.”
Nick and Emily agonized over what to do. “You want to get married, do the right thing,” Emily explained. But on the other hand,
If we do the right thing, are we gonna be able to eat? You know what I mean? We talked about how we had more to lose by getting married, but we thought about it, and decided: God will always make a way through. Always. So, if we did what was right, we would be taken care of, as God tells us.
Nick made a “sweet and thoughtful” proposal, and in May 2022, four months after they began dating, the couple married in a ceremony in their backyard on a gorgeous day, not a cloud in the sky. Emily served chopped lunch meat on Hawaiian slider buns, salad, and chips to the eight people in attendance, including the pastor and his wife, her parents, and close friends.
After the ceremony, it took Emily awhile to get everything filed, but even after she’d reported updates to the county, Emily didn’t hear anything about the status of her benefits for months. When she did hear something, it was only to say that there would be a review process to determine whether she was still eligible for Medicaid. The anxiety was a lot to bear.
When she spoke with a case worker over the phone last October to try to understand what exactly was going on with her Medicaid benefits, the caseworker told her, “Looks like you’re not eligible for renewing anything until January. So just wait until January.” Another time when she called to report an income change, she was told “not to worry about it.”
Emily found the apparent unevenness of enforcement and lack of transparency about what does and does not affect eligibility to be nerve-wracking and antithetical to planning. “I freak myself out because I don’t know what’s really gonna happen. We got one person telling me one thing. I get a letter telling me another. So now it’s like I’m all confused.”
She is especially conscientious about calling to report income changes because she is terrified of accidentally committing fraud. “I get so weirded out with it, and I freaked myself out, like, I’m going to jail…. I did grow up here in town,” she laughs. “But I’m not made for jail.”
Emily agreed that it’d be nice if there were an official and intentional grace period in which people had time to save and plan and look into other health insurance options in preparation for the termination of benefits. One version of this idea, as family policy expert Patrick Brown suggests, is that states could create a “honeymoon period for safety-net programs” to give newlyweds a year or two before they’d be required to recertify eligibility.
Another idea is to double the threshold for married versus single parents when it comes to programs like Medicaid. This could help address the marriage “accessibility issue playing out in American life for young adults,” as Brad Wilcox described in a recent New York Times interview. And while we might assume that this is a federal fix, states can also take meaningful action.
Emily and Nick’s story suggests an additional possibility: make the administration of benefits simple, clear, and transparent. In January of this year, Emily found out that the income threshold had increased for 2024 just enough so that she remains eligible for Medicaid. In this case at least, the impending marriage penalty proved spectral—and yet no less powerful, because even uncertainty about whether “benefits are on the line” can drive marriage decisions.
More clarity and foreknowledge about how marriage might affect benefits could mitigate effects for couples whose fears about disqualification are unfounded, or at least help couples prepare better for a future loss of benefits.
Because even without that added financial uncertainty, marriage requires faith enough.
Editor’s Note: *Names have been changed to protect privacy.