Home > children and families, health care reform, social and cultural issues > Health Care Reform: Seeking the Cure for Tax and Social Justice on the Landscape of Changing Familial Norms

Health Care Reform: Seeking the Cure for Tax and Social Justice on the Landscape of Changing Familial Norms

July 16, 2012

Health Care Reform: Seeking the Cure for Tax and Social Justice on the Landscape of Changing Familial Norms (PDF)

Source: Seton Hall Legislative Journal

Goals of health care reform under the PPACA fall broadly under four categories: cost containment, affordability, improved access and quality of care. The PPACA contains many expansions to the nation’s health care delivery systems for individuals and families alike. For example, insurers are generally prohibited from excluding pre-existing medical conditions and parents may keep dependents on their insurance plans until the age of twenty-six. Furthermore, Medicare Part D will undergo a dramatic facelift, as seniors anticipate a post-doughnut-hole retirement with their prescription drug plans. Moreover, Medicaid is an enormous platform for expansion, as individuals, including those without children, will now be eligible for enrollment and coverage if they are 133% above the poverty line5 Any person who was not eligible for Medicaid on December 1, 2009, and meets these and citizenship requirements will qualify for the expanded program.

While the magnitude of the PPACA will continue to unfold over the next several years, the limitations of the PPACA in meeting its goals will become gravely apparent for the growing number of non-traditional families comprised of gay and lesbian couples and their children. The Defense of Marriage Act (“DoMA”), signed into law by President Clinton in 1996, defines marriage for federal purposes as a legal union between a man and woman as husband and wife. While DoMA purports to relinquish to states the decision of whether to allow gay marriages and civil unions, the legislation excludes same-sex couples and their families from spousal benefits included in federal directives8 Moreover, no state is required to recognize out-of-state same sex marriages, marking the first time that Congress has applied the Full Faith and Credit Clause of the Constitution in a negative fashion.

The implications of the struggle for same-sex couples are manifold. For instance, unlike married couples, domestic partners must pay federal and sometimes state taxes on health care benefits when they are covered under a spouse’s policy. The Internal Revenue Service counts the value of the domestic partner’s benefit as income for the employee. The scene becomes murkier when one partner in a same-sex couple gives birth to or adopts a child, or if one of the partners becomes ill. For example, under the Family Medical Leave Act (“FMLA”), larger employers must provide employees job-protected unpaid leave due to a serious health condition rendering the employee unable to perform his or her job, or to care for a sick family member, or for a new child.

DoMA sharply limited the reach of the FMLA by excluding same-sex partners from caring for one another or for a child who is not the biological offspring of the employee partner in states in which gay marriage is prohibited. Similar limitations apply in the long-term care and hospital proxy settings, which have become particularly distressing for older LGBT couples unable to plan for retirement.

The PPACA creates new programs and provides new federal resources to promote health and provide access to affordable healthcare for American families. Yet, the Department of Health and Human Services failed to interpret the Act’s references to family, child, spouse, parent, dependent, and other terms to connote familial relationships in ways that would recognize diverse family structures. This gap is problematic because American family structures are increasingly varied. For example, the 2000 U.S. Census reported 5.5 million couples were living together who were not married, up from 3.2 million in 1990. The majority of unmarried-partner households had partners of the opposite sex, while an estimated 594,000 households reported partners of the same sex. Other research indicates that approximately two million American children under the age of eighteen are being raised by parents in a same-sex relationship.

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Categories: children and families, health care reform, social and cultural issues
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