Matthew finds his situation pretty ridiculous, really. “It feels like I’m living in a romantic comedy,” he laughs. “I had to marry my best friend just to access treatment for my autoimmune condition. It’s bizarre.” He asked that his full name not be used in order to avoid any backlash from insurance companies due to his unconventional decision.
Matthew isn’t alone; many Americans have wed for reasons tied to health insurance, especially before the Affordable Care Act (ACA). Back then, marriage, divorce delays, and job choices were often influenced by private health insurance, which usually required one’s job to offer benefits.
His choice came as a result of the healthcare cost crisis affecting approximately 24 million ACA marketplace enrollees. With enhanced subsidies set to expire at the end of 2025 and Congress unable to extend them, many people face unaffordable monthly premiums—some comparable to mortgage payments. Lawmakers are currently negotiating potential solutions to restore these subsidies, but others like Matthew are making drastic life changes to stay covered.
“We couldn’t risk waiting for Congress to figure it out,” he says.
“That’s very strange.”
At 40, Matthew lives in a small Michigan town, enjoying his job at a company that unfortunately doesn’t offer health insurance. He needs regular blood transfusions due to his illness. For years, he relied on the ACA, with a manageable monthly premium of $181 for 2025.
Last summer, anxiety began to set in. “I worried about what would happen if the subsidies for the ACA disappeared,” he shared.
When the enhanced subsidy lapses, his premiums could soar to over $427 a month, which felt overwhelming and outside his control.
This is when Christina, his roommate of 25 years and best friend, stepped in. “We met in eighth grade and moved in together after leaving home.” Their bond is strong; they consider themselves platonic life partners. One evening, while discussing insurance options, Christina suggested, “I have great insurance; why don’t we get married?” Matthew’s initial reaction was one of surprise. “That’s odd because, well, I’m gay,” he said.
But Christina reassured him, “Nothing changes between us except for a piece of paper. We just want to make sure you’re covered.” At first, Matthew felt uncertain. Dreaming of marrying a man had always been his vision.
After consulting with their therapists, they both recognized that their marriage would be genuine, despite lacking romance or physical intimacy. “We handle daily life together, have been friends for over 25 years, and lived together for 15 years,” he explained.
Eventually, they tied the knot in September with a modest ceremony attended by their parents and a couple of friends. “Ultimately, I have no regrets,” he said.
Reasons for Marriage
Historically, marrying for practical reasons wasn’t unheard of. Erin Hughes Brown, a health law professor at Brown University, notes that accurate statistics on this phenomenon are sparse.
“The ACA made access to affordable insurance better for many, but with the expiration of enhanced premium tax credits, we might be reverting to a pre-ACA landscape,” she cautioned. Hughes-Brown pointed out that marrying for practical benefits isn’t illegal. “It’s not HR’s job to evaluate the sincerity of a marriage,” she stated. “People marry for numerous reasons beyond love—economic, practical, or raising children, among others.”
Matthew’s new insurance from Christina’s job starts in January, with a premium of $121, similar to his ACA costs. He is now racing to start his treatment. “We hustled to get referrals and pre-authorization to ensure I’d receive my medication in two weeks,” he noted.
Though Matthew is frustrated with his predicament, he remains a supporter of the ACA. He’s hopeful that Congress can reach an agreement soon, emphasizing that not everyone is fortunate enough to have a friend to marry for affordable health insurance.
