In Sickness and in Health (Insurance): Obamacare Uncertainty Leads Couple to the Wedding Altar

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Don Boyer and Ann Justi initially planned to get married in the fall, but moved things up because they were concerned Affordable Care Act rule changes could strand her without insurance.

"This is a first for me," says Rabbi Andy Dubin, as he sits down on a collapsible chair opposite Ann Justi and Don Boyer.

The three of them are in the compact living room of Boyer's apartment in Yonkers, squeezed between the sofa, TV and writing desk. Dubin is in his socks, having shed his snow-caked boots out in the hallway. 

Boyer and Justi are getting married. Never mind the blizzard-like conditions that kept one set of friends home last week, and a bad cold that waylaid another. They're determined to tie the knot this afternoon. So they recruited the landlord from downstairs — and a public radio reporter  — to be witnesses. 

Why the rush?

They've been listening to the news. They were planning to get married in the fall, but it occurred to them that there's no knowing what could happen to health insurance if the Trump administration and Congressional Republicans dismantle the Affordable Care Act.

Justi has several preexisting conditions — osteoporosis, asthma, allergies, Vitamin B-12 malabsorption — and health insurance that will expire this summer (from a previous employer that laid her off last year after working there more than a decade). 

Sure, they say, she could wait until the spring to get married, and she could still go on the health plan he receives as a unionized concierge for a residential building. But what if Republicans unspool crucial Obamacare safeguards before then?

"If the law changes next week and Ann marries me in the springtime, even when she gets coverage under my own plan, my insurer could turn then around and say, ‘Oh well, you have all these conditions that we’re going to deny coverage on,’ " Boyer said. "And that could leave us holding the bag financially or leave her unable to get adequate care."

Much of the focus in the "repeal and replace" debate has been on the 20 million Americans who have received coverage via state and federal health insurance exchanges and Medicaid expansion. But most Americans still get coverage from employers, and their plans now have protections that could also be rolled back.

Under the Affordable Care Act, private insurers can no longer reject people with pre-existing conditions or "medically underwrite" those conditions — charge more. Conditions can include not just diabetes and heart disease, but previous episodes of depression or domestic violence. Prior to the Affordable Care Act, insurance carriers regularly charged more for women of childbearing age who had delivered babies by Cesarean section.

Having temporary insurance with an expiration date, instead of being on a stable health plan that can’t kick her off, takes Justi back to an earlier, uglier time in her life.

"I went from one employer to another, and the new employer's insurance didn’t cover my preexisting conditions for a year and that nearly bankrupted me," she said.

The couple lives in New York, which prevented this problem years before President Obama and Democrats made it federal law. But it's not clear, under Republican rule in Washington, which set of rules would prevail, and what insurers would be allowed to do if the ACA were overturned. 

So Justi and Boyer decided to have a legal marriage as soon as possible, in their living room, and a more ceremonial, celebratory one in the fall. They found Rabbi Andy Dubin online, on a list of licensed local wedding officiants. His profile jumped out at them, even though neither is Jewish.

The service is casual but formal. Dubin wears a suit, and the couple are both fashionably attired in black. Boyer sports a white rose boutonniere. Justi holds a bouquet of Easter lilies, stems wrapped in silk. Dubin talks about marriage and commitment and faith. And he nods to their need to protect themselves.

"Every marriage is important — but it’s also important because you are living in times, as we all are, when sometimes we have to take things into our own hands to make sure we  come out all right on the other side," he said.

For about 20 minutes, they discuss the journey behind the couple and the one ahead. Boyer and Justi read vows they've written to each other, and then put rings on each other's fingers. Dubin declares, "By the authority vested me by state of NY, I now pronounce you, Don and Ann, husband and wife."

They kiss enthusiastically. Then they sign some paperwork, raise a toast of sparkling water, take some smartphone pictures, and embrace the rabbi.

They're beaming like newlyweds — albeit very practical newlyweds, planning for the future.

"As quickly as possible, I want to get you and this form down to the union headquarters tomorrow," Boyer says.

And that’s it. The landlord heads back downstairs. The rabbi and I head out into the snow. And Justi and Boyer bundle up for a one-night honeymoon in a White Plains hotel. They say they’re prepared to face whatever comes next together – in sickness and in health.