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universal healthcare
Trapped by Coverage: How the US Healthcare System Ties Survivors to Abuse
Universal healthcare, or at least a robust public option, would give Americans the freedom to leave jobs or relationships without fear of losing coverage.
Feb 03, 2025
Many people are nervously awaiting the fate of the Affordable Care Act, or ACA, under the new administration. If the ACA is repealed or restricted, countless women in abusive relationships could be forced to risk losing their spouse's healthcare coverage should they decide to leave.
For millions of Americans, healthcare is tied to jobs or marriages, creating dangerous dependencies. In 2023, over 60% of Americans under age 65 relied on employer-sponsored health insurance. Of these, one-quarter of women under 65 received their health insurance through a spouse’s plan.
I witnessed the devastating consequences of this firsthand during my 10 years working with a governmental agency dedicated to supporting individuals in “high-risk” domestic violence situations—cases where abuse was severe, frequent, and life-threatening. In this role, I provided crisis intervention, safety planning, and emotional support to survivors navigating unimaginable challenges. One woman I worked with called me from the doctor’s office one afternoon in tears. She had just been treated for a fractured eye socket. Her partner had thrown her against a wall the night before. While she hadn’t disclosed the cause of her injury to the medical staff, she had shared the truth with me.
Today, healthcare access is largely determined by employment and marital status, reinforcing economic inequality, gender-based harm, and rigid social roles.
Her distress, however, wasn’t about the medical care she received. It was about the idea of losing access to that very care if she ever left her partner. Ironically, the same healthcare that tended to her physical and emotional wounds was tied to her abuser’s job. Without him, she and her children would lose their health insurance entirely.
This tragic irony is the daily reality for countless individuals across the United States. For people in abusive, coercive, or manipulative relationships, healthcare tied to marriage gives abusers significant leverage. Leaving an abusive partner is never a simple decision, but the threat of losing health insurance—often for their children as well as themselves—makes it even harder. Survivors are forced to weigh their personal safety against access to life-saving care.
Employer-sponsored health insurance wasn’t always the norm. Before World War II, Americans typically paid out of pocket for medical procedures. But in the 1940s, wage controls during wartime prevented employers from raising salaries, so they began offering health insurance as a perk to attract and retain workers. Over time, this temporary solution became a default system, expanding to include dependent and spousal coverage as societal norms emphasized “family-centric” policies.
What began as a short-term fix has since created a web of unintended consequences. Today, healthcare access is largely determined by employment and marital status, reinforcing economic inequality, gender-based harm, and rigid social roles.
For survivors of domestic violence, this system compounds an already harrowing situation. The research shows that approximately 99% of domestic violence survivors experience financial abuse. Healthcare is often one of the financial tools used to exert control. Survivors may be blocked from accessing care, forced to remain in harmful relationships, or deprived of medical resources if they attempt to leave.
But the problem doesn’t end with domestic violence. The employer- and spousal-based healthcare system pressures people to conform to outdated family roles, leaving out millions who live outside traditional employment or family structures. For example, why shouldn’t someone be able to add a sibling, an elderly parent, or a close friend to their health insurance plan? Our narrow definitions of “family” exclude many from the support they need during life’s most challenging moments.
The good news is that change is possible. While we may not yet be at a point where we can fully separate healthcare from jobs and marriages, we are at a critical juncture where we can challenge the status quo and push for meaningful reform.
The Affordable Care Act was a significant step forward, but public options remain prohibitively expensive for many Americans. On average, employer-sponsored plans cost workers around $6,200 annually for family coverage, while public plans, without subsidies, can be more expensive. Closing this gap through expanded subsidies or premium caps must be a priority.
Current laws offer some protections. For example, domestic violence survivors qualify for health insurance enrollment outside standard open enrollment periods under the ACA and many private plans. But these policies are undermined by prohibitive costs and complex administrative processes, creating unnecessary barriers for those already in crisis.
Administrative barriers like these need reform. The ACA’s rollout was marred by technical issues, and today, many Americans still face confusing, inefficient systems that discourage participation. Streamlining the enrollment process and raising public awareness of available options would go a long way toward ensuring equitable access.
Long-term, we must move toward a system where healthcare access is no longer tied to employment or romantic relationships. Universal healthcare, or at least a robust public option, would give Americans the freedom to leave jobs or relationships without fear of losing coverage. No one should have to choose between their health and their safety, or between financial security and their autonomy.
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Murder of Health Insurance CEO Exposes Depth of Rage Over Corporate Greed
The killing of Brian Thompson, as horrendous as it was, forced us to confront the injustices we’ve been taught to tolerate.
Jan 02, 2025
Call him a misguided hero or villain, but the man who killed the United Healthcare CEO struck a nerve, exposing a deep rage shared by many Americans across the political spectrum—anger at an industry that earns obscene profits from the suffering of others. His chilling act shifted the national conversation from immigration to corporate greed. Finally.
For too long, Americans have hesitated to criticize the super-rich. Chalk it up to our tribalist nature that has so many convinced that our financial struggles are caused not by wealth hoarding but by those we view as outside our clan.
History offers many examples. In Nazi Germany, Jews were blamed for a financial depression triggered by the American stock market crash. My parents and grandmother barely escaped; many in my family did not.
Decades later, Ronald Reagan handed the wealthy the largest tax cuts in U.S. history while vilifying the “Welfare Queen” who leached from the feeding trough of “Big Government.”
This racist caricature was meant to distract from policies that began a 40-year transfer of wealth from the 90 percent to the one percent, producing the largest wealth gap in a century. It’s a story about the undeserving poor vs. the deserving rich.
Today, we face a similar narrative. Immigrants are blamed both for stealing jobs and freeloading despite their essential role in propping up our economy given our shrinking workforce. After being fed a steady anti-immigration media diet, it’s not surprising that nearly four out of five Republicans support placing undocumented immigrants in internment camps.
The greater the wealth imbalance, the more the wealthy need to distort the truth. They peddle the long-discredited Trickle-Down theory, claiming that what benefits them benefits us all. But rising tides don’t lift all boats when some people have no boat at all, or when their boats are sinking because the superyachts are capsizing small craft in their massive wake.
We have to stop believing that billionaires have working people’s interests at heart. In fact, they’re mutually exclusive. A gangbuster stock market depends on keeping wages low and unions banished. Outsized campaign contributions ensure that corporate taxes are slashed and regulations meant to keep us healthy, safe, and not impoverished are gutted.
It makes complete sense that the wealth lobby exploits fears of “socialism” to keep people voting against their own interests. It’s no coincidence the U.S. remains the only developed nation without universal healthcare. This is where our anger should be directed.
But redirecting anger is not easy. Six of the richest US corporations control 90 percent of our media and their profits depend on algorithms and news coverage designed to keep us divided, misinformed, and distracted from this billionaire plunder. “You know the media has failed,” says essayist Rebecca Solnit, “when people are more concerned that a trans girl might play on a softball team than that the climate crisis will destroy our planet.”
During the next four years it will be critical to get people to see through this deception. When we start feeling the fallout from a second Trump term, the scapegoating will intensify. Tariffs, more tax cuts for the rich, and the loss of immigrant labor will send prices soaring and balloon the deficit. Many may lose healthcare, Social Security, and worker protections. The wealth lobby will no doubt point fingers elsewhere.
Change is possible though. As a grant writer for 30 years, I’ve seen campaigns shift public opinion on issues like marriage equality, net neutrality, and climate change. Recently, several states won historic economic reforms after decades of trying. In Massachusetts, RiseUpMass won the nation’s sixth millionaire’s tax by debunking claims it would harm retirees.
In Washington state, the Balance Our Tax Code, a coalition of over 80 diverse groups, from home health aide workers to members of the Yakima Nation, was able pass a capital gains tax, calling out Amazon and Microsoft for avoiding their share of taxes. “The biggest lesson we learned,” said campaign communications manager Reiny Cohen “was that when we come together and tell the same story, lawmakers have no choice but to listen.”
In other words, changing minds requires a coordinated echo chamber. The #MeToo movement showed how the right framing, amplified through the media, can shift perspectives and galvanize action. Imagine if we could help more people connect the dots between stagnant wages, failing schools, a burning planet, unaffordable housing, and the greed of the one percent.
But the message must go beyond bashing billionaires. It must present a compelling vision of what is possible if we stand up against the ultra rich. The We Make Minnesota coalition was able to pass a tax increase on the wealthiest one percent by countering anti-Somali rhetoric with a “We’re Better Off Together” message. Instead of using a “Stop the Cuts” framework, the campaign emphasized the subsidized health care, free preschool, and tuition-free college programs the state is now able to offer.
This isn’t about destroying capitalism. A healthy balance between a free market and protective government is essential. But when the richest among us prioritize profit over the well-being of the majority, it’s no longer about politics—it’s about survival.
The murder of the United Healthcare CEO, as horrendous as it was, forced us to confront the injustices we’ve been taught to tolerate. This moment must unite us against the true enemies of the American dream: unchecked greed and exploitation of the many for the benefit of the few. We can either remain manipulated by scapegoating and fear or see the truth and demand change. Only then can we build a society where no one feels driven to such desperate measures again.
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62% of Americans Agree US Government Should Ensure Everyone Has Health Coverage
The new poll shows the highest level of support in a decade for the government ensuring all Americans have healthcare.
Dec 09, 2024
Public sentiment regarding the nation's for-profit healthcare system—an outlier among wealthy nations—has dominated the national news in recent days following last week's killing of an insurance executive in New York.
On Monday, just hours before a suspect in the murder of UnitedHealthcare CEO Brian Thompson was arrested by police, a new Gallup poll found a 62% majority in the U.S. believe the government should ensure all Americans have healthcare coverage—the highest percentage in more than a decade.
Just 42% of people in 2013 believed it was the government's responsibility to make sure everyone in the country had health coverage—a low since the beginning of this century.
The poll found that a majority of Republicans still believe ensuring health coverage is not the government's job, but the majority has shrunk since 2020.
That year, only 22% of Republican voters believed the government should ensure everyone in the country has healthcare, but that number has now grown to 32%.
The percentage of Independents who think the issue is in the government's purview has also gone up by six points since 2020, and Democratic support remains high, currently at 90%.
Americans have vented their frustrations about the current for-profit health insurance system in recent days as police searched for a suspect in the killing of UnitedHealthcare CEO Brian Thompson, before arresting Luigi Mangione in Pennsylvania on Monday. Mangione, according to claims by police, was found with a manifesto that railed against the insurance industry.
Anthem Blue Cross Blue Shield last week also faced public outcry and was forced to reverse a decision to slash coverage for anesthesia care, with U.S. Rep. Ro Khanna (D-Calif.) saying the move indicated that "the current system is broken."
"Democrats will regain trust by standing up to special interest insurance companies and fighting for Medicare for All," he said.
President-elect Donald Trump and other Republicans, who are set to control both chambers of Congress starting in January, have indicated that they would go in the opposite direction, working to weaken the popular, government-run Medicare program by promoting Medicare Advantage, which is administered by for-profit companies like United and is already used by half of Medicare beneficiaries.
But one of Trump's top allies, billionaire entrepreneur Elon Musk, waded into the debate last week about the current healthcare system, questioning why the U.S. pays far more in administrative healthcare costs than other wealthy countries and suggesting Americans don't "get their money's worth."
Another poll released last Friday found Americans' positive opinion of the nation's healthcare quality has declined to its lowest point since 2001, with most agreeing the U.S. system dominated by private insurers has "major problems."
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