NCPA - National Center for Policy Analysis

The Effects of the Affordable Care Act on Work and Marriage

November 11, 2011

Though the Patient Protection and Affordable Care Act (ACA) is most often discussed in terms of its effects on health insurance and medical care costs, the ACA will have numerous effects in various facets of American society.  Specifically, its financial and taxing system will create incentives that perhaps the authors of the bill did not foresee, including that the average American worker will be discouraged from marrying and working in a wide range of circumstances, says Diana Furchtgott-Roth, a senior fellow with the Manhattan Institute.

The primary difficulty with this system is that it stipulates an individual's premium payment toward their health insurance based on household income, failing to account for the circumstances of the family structure.

  • This negatively affects incentives to marry because marrying (and the shared household that customarily follows) serves to combine the spouses' incomes.
  • When this combination moves a couple into a higher bracket of income (measured as a percentage of the poverty line) than the two people were in prior to marriage, it reduces the government's assistance in paying for their health care significantly.
  • Thus, the ACA's premium payment rate structure makes marriage financially costlier.

Additionally, the ACA's structure furthers this problem by reducing incentives to work -- especially in married couples.  Upon getting married couples will undoubtedly notice that their health insurance premium will become significantly more expensive.  The difficulty with this situation is that many will respond by attempting to make less money, thereby moving the newlywed couple back into a lower bracket.  This drive can manifest itself in several ways, whether they be that one of the spouses no longer attempts to get a promotion or leaves the workforce altogether.

Source: Diana Furchtgott-Roth, "The Effects of the Affordable Care Act on Work and Marriage," Testimony before the Subcommittee on Health Care, District of Columbia, Census and the National Archives of the House Committee on Oversight and Government Reform, October 27, 2011.


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