Last week, the Supreme Court overturned part of the federal Defense of Marriage Act. Last year around the same time, the Supreme Court upheld most of the Affordable Care Act (the ACA or “Obamacare”). Importantly, these two landmark decisions affect one another. The dissolution of the Defense of Marriage Act (DOMA) has important implications for expanding health insurance under the ACA. By federally recognizing same-sex marriage, the health insurance formula changes.
For starters, for individuals who don’t qualify for Medicaid, the ACA provides subsidies for citizens and legal immigrants to purchase insurance based on their income. Those subsidies are determined by the federal poverty line, a number which is dependent on the size of one’s family. In a world without DOMA, same-sex couples now count as one family, changing the federal poverty line requirement. Depending on the combined incomes of the two individuals, they may either gain or lose out on federal subsidies. In addition, same-sex couples living in states that recognize marriage equality will be able to apply for joint health insurance and have that joint insurance recognized by the federal government. This means that if one person in the marriage didn’t have health insurance but now can be claimed by their spouse, they will be covered when the 2014 requirement kicks in for all individuals to have health insurance.