Gay Marriage and Healthcare

One of North Carolina’s uber-conservative Senators is introducing – as someone has for every year since 2004 – a state constitutional amendment that would prohibit gay marriage.

That in itself is not such a big deal to me. I don’t care about the religious connotations of “marriage”, but do think it patently unfair that individuals who are similarly situated are not afforded the same legal rights in this country. For the most part, other than the 1,031 extra categories of taxes that LGBT people must pay that aren’t imposed on straight married folks, I can accomplish the same results through legal manipulation.

It ain’t easy, but it can be done. It irritates me to no end, though – same sex couples pay the same taxes, obey the same laws and have the same responsibilities. We should be afforded the same benefits under the law.

It also has nothing to do with all the hoopla over forcing churches to violate their principals and perform marriages; there’s a difference in a civil relationship and a religious one which many people can’t seem to comprehend. The church people are free to go off and do or believe whatever they’d like. From a civil aspect, though, there’s not a legitimate reason in the world that any two adults cannot go to the courthouse, pay the fee and obtain a license to legally recognize their relationship.

Would anyone argue that a woman should not be able to get a driver’s license simply because of her gender? Other than religious beliefs – in which we are supposed to be able to follow our own consciences in this country – there is no legitimate argument for prohibiting same sex marriage.

This time there is a difference in the proposal, though. The Senator who is introducing this bill – a particularly virulent fundamentalist who’s offered similar bills up before – seems to be expanding it a bit this time. Instead of just prohibiting marriage or the recognition of any civil domestic arrangement between individuals of the same sex, it is also going to try to prohibit anyone – including private companies – from recognizing same-sex couples in any way.

What does this indirectly mean? Let’s just look at one example – healthcare.

Companies that offer healthcare benefits to same-sex partners will now be prohibited from doing so in North Carolina. Not just government agencies, but private companies that now offer this will not be allowed to do so.

Aside from the disincentive for big businesses to locate here – many now offer this benefit, some because of state law mandates in other locations and others just because it’s the right thing to do and what they have to do to entice quality individuals to work for them – it will result in a significant number of people who currently have health insurance becoming uninsured.

I hadn’t thought about it until I was talking with a friend of mine yesterday. He and his partner, both of whom are employed, get their insurance through the partner’s job. My friend works for a small company that doesn’t offer that kind of benefit.

If he were buying insurance on the open market, it would be about $500.00 a month – the cost through his partner’s employer is about $200.00 a month. It’s even worse because his two children get their insurance through the partner’s job as well. Try to buy coverage for an adult and two children – you’re looking at about $650.00 a month, with a $2,500.00 deductible and no dental coverage.

The first thought someone else might have would be, “Wow. He will have to pay another $7,300.00 a year for healthcare coverage. That’s gotta suck for him.”

Let me tell you how it sucks for all of us, though.

On $36K a year, he’s not likely to buy that insurance for a couple of reasons. First, it simply won’t fit into the budget, especially with two kids that age. Instead, he’s likely to take the risk that he’ll use less than $7,300.00 a year in healthcare, even with the kids. Every year he spends less than that is a year that he makes money (or at least doesn’t lose as much) gaming the system.

Here’s the bigger reason, though. Some stuff can just go by the wayside. Although it's not quite as effective, most minor stuff kids get can be treated over the counter. Same for adult maladies -- chronic indigestion and the occasional cold or sinus infection is dealt with through a trip to Walgreens. Annual checkups for adults aren't really that important, especially if you're looking at dropping $500+ out of your own pocket, and sometimes the kids can get a “physical” through the sports programs at school.

Here's the other thing, though. Even if they have a bad year – car wreck, broken arm from falling off a bike, heart attack, cancer – whatever major illness or injury you want to name – they’ll still get treatment regardless of their ability to pay. There’s a federal law on the books called EMTALA – the Emergency Medical Treatment and Active Labor Act – that requires all healthcare facilities to treat anyone, at least to the point of stabilizing whatever medical condition a patient has and working towards remedying the situation. There’s a lot more to it than that, but that’s the foundational premise.

The result is that he won’t have to pay for my medical treatment, either for himself or his kids. You and I do. Along with every other taxpayer out there, because there are no reimbursement provisions in EMTALA. The hospital has to treat and just bump up everyone else’s costs to pay for the services that people in this situation would receive. It’s one of the reasons that emergency departments in hospitals have become primary healthcare providers rather than “emergency” providers.

It's free and there are no repercussions. Sure, the hospital will send you nasty letters about your bill, but those are easily ignored, especially if someone is worrying more about a major illness or health condition. Get your friend the lawyer involved and it’s even easier to delay, if not avoid, payment.

So because of the religious bigotry of some who will undoubtedly have a slick campaign pointing out the evils of same-sex marriage and who will have buried this requirement which will prohibit his partner from BUYING insurance with THEIR money deep in the language of the bill, my friend and his two children will become uninsured and will rely on the rest of society to pay their medical bills.

Where we’ll all be unlucky is that it would take a lot more of his time, and quality of life might not be quite as good as before. Instead of going to his doctor for checkups like he does now – and for which he pays the copay and his partner’s insurance company pays the balance – they’ll likely wait until someone is truly sick and then go to the emergency room of our local healthcare facilities where the facility will be required to do many, many more tests and examinations – all at a higher cost – to rule out lots of things and then figure out how best to treat the condition I presented.

Is this really what’s in everyone’s best interest?