When Equality Doesn't Abolish Unfairness
By Laurie Ruettimann
I recently met a CEO of a consulting firm in Minnesota who is very proud of the fact that—despite rising medical costs and the inconsistent political, economic, and social landscape in America—his company offers health-insurance benefits to same-sex couples.
“I am doing something the government can’t do,” he told me. (Or, rather, won’t do.)
About fifty million Americans under 65 are uninsured, while the number of people covered by private health insurance continues to shrink. This gentleman’s small business, with fewer than fifty full-time employees, is out on the edge of glory. He is fabulously bucking the corporate trend to reduce coverage, limit exposure, and blame the federal government for tying his hands.
So when he told me about his company policy, I seriously thought, Hey buddy, thanks for doing America a favor. What a hero. I am surprised you’re not wearing tights and a cape.
Then I asked him if he extends domestic-partner benefits to heterosexual couples, he said, “No, those people can get married.”
Ay. There’s the rub. The chief exec’s superpowers go only so far.
Health insurance in America is—to use a very clinical term—jacked up. We participate in an employer-based system in which companies contract with private health-insurance organizations to offer coverage to qualified adults and dependent family members. And the definition of who qualifies as a “family member” varies from state to state. Although the federal Defense of Marriage Act supersedes state law, Massachusetts, Connecticut, Iowa, New Hampshire, New York, Vermont, and the District of Columbia now issue marriage licenses to same-sex couples. Meanwhile, civil unions and domestic partnerships in a patchwork of other states and local jurisdictions provide certain rights and benefits to gay couples.
That’s great! Marriage equality is progress for everyone in America. But this twenty-first-century civil-rights movement means that lawyers, HR departments, and CFOs must review healthcare options, take into consideration the changing landscape of marriage, and offer total compensation packages that can screw people. Why? Because it is really difficult to properly support and fund inclusive work environments while remaining fiscally responsible and accountable to shareholders and corporate boards.
When health care intersects with marriage and personal relationships, which it does on a daily basis, it’s a mess. At one company, same-sex couples are covered regardless of marital status or state laws. At another, the assumption is that everyone—including heterosexual married couples—is out to defraud the system. No one is above suspicion, and a tremendous amount of time and energy is wasted on fraud investigations.
Then you wonder why HR ladies are crabby and frumpy? It’s because we are caught up in the chaos of states’ rights, changing political hermeneutics, and difficult economic times. Plus you expect us to plan the company picnic, too?
With the rise of marriage equality in America, some HR departments are trying to streamline benefits administration through the simple act of going retro. The thinking is simple: If we require heterosexual couples to marry in order to receive coverage, shouldn’t we place the same burden on newly empowered gay couples in states like New York and Iowa?
This is not a crazy idea. After all, it’s setting the same standard for insurance-participation eligibility for all couples in states where same-sex marriage is legal. Although not ideal, there is no perfect way for your local HR department to balance the mandate of diversity and inclusion with the very serious realization that one major health-insurance claim could bankrupt a self-insured health plan. Why not demand marriage of everyone where possible?
Unfortunately, when a company requires that people marry to qualify for health insurance, there are significant social implications. In a 2008 poll by the Los Angeles Times and the Henry J. Kaiser Family Foundation, 7 percent of Americans said they or someone in their household decided to marry in the last year to get healthcare benefits via a spouse. This is called an “insurance-card marriage,” and for the quarter of working-age adults who are uninsured, this can often be the only realistic option to obtain medical care.
To make matters worse, there is a growing trend these days called the “non-divorce,” where couples separate but retain their married status to continue participating in health-insurance programs. This common practice violates the spirit and intent of most employer-funded insurance programs, but good luck trying to talk people out of it. And good luck kicking them out of your healthcare pool.
The complicated system of healthcare coverage in America is built on a social structure in which very few people win. Instead of having the courage to call for major reform—such as taxing revenue at a greater rate and opening up Medicare for all Americans to participate—most HR departments and CEOs roll over, adopt a partisan tone, and complain about the “Obamacare” compromise.
Where’s the corporate leadership?
In the absence of major change, companies should still work to optimize a broken system by offering benefits to partnered couples and dependents regardless of state laws, regardless of gender, and regardless of marriage status. It doesn’t fix the system, but the effort is not lost when it improves the lives of many Americans. Meanwhile, any CEO who is proud to offer coverage to same-sex couples as a solution to a faulty healthcare system has his head on backward. He ought to be fighting, tooth and nail, to remove the responsibility of medical coverage from internal and external shareholders and place it solely where it belongs: with the federal government.