My wife and I are going to the wedding of two close friends this weekend. Tammy and Emily have been together almost as long as my wife and I have been together. Together they have adopted a cat, bought a house, kept each other from punching family members who were curious if the lesbian thing was just a phase, put up with annoying parents who wanted grand kids five years ago, cheered each other on, bitched about bad bosses, been a source of calm and comfort in times of stress, and otherwise helped each other to be the best person that they want to be. And they do it together with a smile, a laugh and an easy grace.
We are looking forward to their wedding as both a night out without kids, and as a means of celebrating two really good friends being really happy together.
Over the summer, we talked about health insurance. It looks like it still makes sense for them to keep seperate employer sponsored policies as both of their employers will pick up most of the cost of the employee but provide little subsidy to a spouse. During that conversation, I started to think about pricing models.
Same sex marriage, at least in the states that allow it, and under the condition that both members are sero-negative, is a decent employer sponsored health insurance subsidy to the breeders.
Let’s look back a couple of weeks at the University of Georgia System open enrollment packet. Let’s look at only Comprehensive Care total premiums:
Employee Only: $515
Employee plus Child: $928 (kid costs $413/month)
Employee plus Spouse: $1083 ($568 per month to add the legally entangled other adult)
Employee plus family: $1,495 ($980 to add another adult and at least one kid, or $412 to add at least a kid to the Employee plus Spouse)
There are a couple of pricing rules of thumb that we need to know. The first is that employer sponsored health coverage acts as a health screen. You have to be healthy enough to work to get employer sponsored coverage. Men at almost all ages in the employer sponsored risk pool are cheaper than woman. This is for two reasons. The first is pregnancy is expensive. The second is women in general use more health services on average for relatively low disease burdens. They tend to be smart and get problems addressed. The add-ins of family members are not subject to the de facto health screening of employment so they tend to be a little sicker than average. A spouse who is brought on to a policy is risky. If they are being brought onto another’s policy, that means they either have no other source of insurance, are unemployed (with attendant health risks there) or are looking for the best deal because they know they are more likely to be high users. Iam suprised that Employee plus Child is as expensive as kids over the age of 1 tend to be dirt cheap. They use a lot of PCP visits, but not a lot of the expensive, intensive care.
A spouse covers a lot of correlated risk that an employer only policy does not. A single male does not face pregnancy risk. A single woman at a middle class position which tends to have a disproportionate number of college educated employees has a fairly low pregnancy cost risk associated. Hetero marriage changes that. Pregnancy risk and its attendant $10,000 claim goes up significantly. Male utilization patterns change to slightly more utilization on lower level care. Guys still don’t get enough low level care, but married guys get more care than their unmarried counterfactual selves. And if the woman in the married couple if past prime pregnancy age, the insurer is now highly likely to be covering two middle age or older people with all of their pre-existing conditions coming into play.
Here is where I think same sex marriage is a subsidy to breeders. Two sero negative guys who are now married and sharing a joint policy still have absolutely no insurable pregnancy risk. They are also less likely to change their health care consumption patterns due to their spouse telling them to get that bum knee checked out as the spouse would never have thought it was something worth checking on if it had happened to them.
If Tammy and Emily were to go on a shared employer sponsored policy from one of their employers, their risk profile is different than a hetero-couple marrying. They have absolutely no ‘oopsie’ honeymoon pregnancy risk. They are also less likely to change their individual pre-married healthcare consumption patterns for two reasons. They already have demonstrated individual willingness to get things checked out and Tammyy has done a good job of getting Emily to like vegetables and otherwise take good care of herself over the past decade. Emily already achieved the wife’s influence on getting her soon to be spouse to utilize medical care slightly more.
Two guys covered by a couple policy are a massive subsidy to hetero couples. Two women are probably a slight subsidy.
Warren Terra
Congratulations to them.
Please do let us know in what way(s) they have adapted their cat, though. I’m full of curiosity!
Baud
@Warren Terra:
When I first read the title, I wasn’t sure if it was a Princess Bride reference or a typical RM typo.
Elizabelle
Cool. Marriage and war in the same word.
You have gone “The War Between the Tates” one better.
Congrats to Tammy and Emily, and interesting post.
Tommy
Yeah, a happy story. So happy for Tammy and Emily. Also happy the majority of our nation and the courts have finally come around to same sex couples getting married isn’t really a “big” deal (although for them clearly it IS). Now I know many have been fighting for this right for decades, but as a straight dude, kind of from the outside looking in on this topic, it feels like so much as happened in just a few months. Like a tidal wave spewing almost the entire nation. I couldn’t be happier.
Tommy
@Warren Terra: Well I tried to “adapted” my cat with a costume the other day to take a few pics and send in for the calendar here. Now before I go on my cat is on my lap for hours a day if I am in any chair that isn’t my desk chair. I could “manhandle her.” Pick her up at any time and she almost goes limp in my arms wanting to be held and petted.
The costume, well she was having NONE of that. Not for a split second. I had to go out for some alcohol and hydrogen peroxide to tend my scratch marks on my hands and arms. She even hissed at me. But I guess at some levels I can relate, since it would be pretty hard to get me in a costume as well.
JGabriel
Richard Mayhew @ Top:
That’s cruel! Forcing a confused kitty to adapt! What did they adapt it to?
Okay, you just typed this before you had your coffee this morning, right?
Tommy
That is such a smart, but simple and straightforward analysis, but one I had never thought of it in those terms.
Richard Mayhew
@Warren Terra: the cat now shoots fricking lasers out of her fricking eyeballs
Isn’t that the obvious adaption.
And really, cats can adopt people, but do they recognize that people can adopt them; instead, I contend that people can adapt to the cats that have chosen to keep them around… or there was a typo— your choice
Warren Terra
@Richard Mayhew: It’s the problem with spellcheck; typing errors that survive the process are real words, with real and often amusing meanings. I wouldn’t blink twice at “adppted a cat”, or even at “adqpted a cat” – but say you’ve “adapted a cat” and I can’t help but wonder how.
Tommy
Can I ask the smart people here a question? I am thinking of hiring an employee. I work for myself but there are two areas where a person that had more direct experience could reduce my time greatly and allow me to both do more work and charge more. I’ve wanted to do this for awhile, but income wasn’t high enough. I have two new large clients recently with monthly retainers where I could afford to bring on another person.
I say that as background. Also I don’t want to hire anybody and not provide healthcare. I worked at small firms of less than ten people once. Less than five at one. They always provided me healthcare. Said they wanted the best people to work for them. Wanted me healthy and happy. It was the cost of doing business to provide healthcare where they paid the most.
I want the same business model, because I am sure I worked harder for those firms because I knew they were looking out for me if I looked out for them.
So in a long winded way my question. Where can I go to learn how to set-up a health plan for another individual? Maybe a third or a fourth? Can I call a health insurance company and ask for a plan or two? A proposal? The ACA exchanges?
I ask, what some might think is a very basic question, but I really don’t know.
And finally I should note there is like a 95% chance that person I hire isn’t in the same state as me, much less the same metro area. A “virtual” thing.
Richard Mayhew
@Tommy:
Short answer — all of the above are valid ways to set up an employer sponsored health plan. Another option is to not set up a health plan, and pay your employees a whole lot more and let them find a good plan on the Exchange in their state.
Long answer — check your e-mail in a couple of minutes.
Tommy
@Richard Mayhew: Thank you. Thank you. Processing sent via email.
a hip hop artist from Idaho (fka Bella Q)
I’ve never been able to successfully adapt a cat, so my hat’s off to the happy, soon to be married couple. Is there a way to avoid use of the term breeders? I’m old enough to still hear the venom (often at me) with which it was used by gay men who really did not like women. Think Andrew Sullivan with better taste in politics, attire, and philosophy. And better looking, also too.
delk
Congrats! I hope they have a delicious wedding cake baked with love and a warm and welcoming venue!
Randy Khan
The hypothesis that a male-male seronegative couple will be like a single male in terms of usage is interesting, but I am wary of that generalization. In the absence of actual research, I would think there’s a fair chance that hypothesis would be wrong. Just to pick one example, I suspect there is somewhat more incentive for gay men to go to the doctor than for straight men because of the higher risk of HIV.
Starfish
Why is unemployment a health risk? Even though it is old fashioned, stay-at-home parents still exist.
Marcus
“Adapt a Cat”: It refers to adjusting you life around a cat. Learning to live with cat hair on everything, but the cat/the cat running around the house for no good reason (that you can determine) at 3am/learning which wet food is acceptable and which is not/finding out that a closed bathroom door is not allowed/plus other adaptations required when adding a creature to your life which was once worshiped as a god, and knows it.
gvg
I know two gay men with 2 children. They did not acknowledge their tendencies early on and both try to be good fathers. Both divorced, one didn’t have custody and I don’t know about the other as the divorce was decades ago and grandkids are growing up.
I think I know a lesbian who was trying to adopt through foster care but she didn’t chose to actually say at the time and Florida was legally against gay/lesbian adoptions then. I say legally because the impression I got was that some of the agencies employees were trying not to notice so that they could have slightly more kids to finally get forever homes.
People live complicated lives and a lot of them want children in spite of their love lifestyle. I am sure they have fewer pregnancies but I would not assume no chance, especially since artificial insemination is an option. I guess I am just being contrary though although I suspect people being slow to realize or acknowledge their own differentness is still going to be a factor.
Richard Mayhew
@gvg: For two gay guys — can definately have kids, but will Bob impregnate Bill this year even as an oopsie or vice versa, as that is the relevant question from an insurance point of view. Insurers don’t cover adoptions, they don’t cover surrogate medical costs, they don’t cover any medical expenses that can get two guys a kid.
Tammy can’t knock up Emily, nor can Emily knock up Tammy. Sure, they have a much eaier time getting pregnant (turkey baster or a good friend etc) than Bob and Bill, but the odds of an oopsy are fairly low.