When he stops to think about it, Mathew says, his situation feels kind of ridiculous.
"I find myself in the middle of some sort of rom-com plot," he says. "For me to be able to see my doctor to tend to my autoimmune disease, I had to marry my best friend — it's like some weird twisted plot of Will and Grace."
Mathew asked NPR not to use his full name because he fears repercussions from his health insurance company if it finds out he got married to obtain coverage.
He is not the first American to marry for affordable health insurance, and he won't be the last. Especially before the Affordable Care Act, marriages, delayed divorces and job decisions were often tied to private health insurance, since it usually required you or a spouse to have a job with benefits.
But his decision was forced by the cost crisis facing many of the roughly 24 million people who get their health care via Affordable Care Act marketplaces. Enhanced subsidies that made plans affordable for many people expired at the end of 2025 and Congress failed to extend them before the 2026 plan year. Millions of people face untenable monthly premium prices — as much as the cost of a mortgage for some families.
Congressional lawmakers are back at the table working toward a deal that could revive the enhanced subsidies. In the meantime, some have decided to forgo insurance or make drastic changes to their lives to stay insured, like Mathew.
"I couldn't afford to wait for Congress to make up their minds and come to an agreement," he says.
"That's so weird"
Mathew is 40 years old and lives in a small town in Michigan. He loves his job, but the company is too small to offer health coverage, and he has an auto-immune condition that requires medication transfusions. For several years, he's relied on the Affordable Care Act for coverage. He liked his plan, and his $181 monthly premium for 2025 was manageable for him.
Then, in the summer, Mathew started to get nervous.
"I started seeing things about — what's going to happen when these subsidies lapse for the ACA in the marketplace?"
When the enhanced subsidies expired at the end of the year, his premium would go up to over $427 a month, "which was just not an expense I could manage."
Enter Christina, Mathew's roommate and best friend of 25 years. "We met when we were in eighth grade and when we both moved out of our family homes, we moved in together and we've lived together ever since," he says.
They're basically platonic life partners, he says. So as he was weighing what to do about his insurance, one night, she turned to him.
"She's like, I have great insurance — why don't we get married?" he says. "And I said, 'Well, that's so weird because I'm gay.'"
He remembers her responding: "It wouldn't change anything between us other than a piece of paper and we're making sure that you have what you need."
He said he really wasn't sure at first. "I've always been kind of like a romantic, and I've always envisioned myself getting married to a man," Mathew says.
They had a lot of discussions, a lot of talking things through with therapists. "We both came to the realization — there's nothing really phony about our marriage other than the fact that we're not romantic and we were not physical with each other," he says. "We share the burdens of day to day life and we have for over 15 years of living together and 25 years of friendship."
So they did it. In late September, they had a small ceremony at a local church, with both sets of parents and two friends. "Ultimately, I have no regrets," he says.
Many reasons for marriage
Marrying for benefits used to be more common, says Erin Fuse Brown, health law professor at the Brown University School of Public Health, although she notes there are no hard numbers of how many people do it.
"With the advent of the Affordable Care Act, this question faded to some degree because there were better options for someone who didn't have access to employer-sponsored coverage to get covered in an affordable way," she says. "With the expiration of the enhanced premium tax credits, we're now starting to slowly walk back toward a pre-ACA world."
Marriage for benefits is not against the law, Fuse Brown notes.
"If you say this person is your partner, it's not the job of the HR department — or the law — to question: how sincere is this person's marriage?" she says. "People get married for a whole bunch of reasons that are non-romantic — they could be economic, they could be practical, they could be childrearing, there could be any number of reasons."
Mathew's new health plan through Christina's job started in January, and it costs $121 per month, not too different than his subsidized ACA premium.
Now, he's scrambling to get his care up and running under the new insurance. "I have been in a mad dash of securing referrals and prior authorizations to be able to get my medication in two weeks time," he says.
It frustrates Mathew to find himself in this situation. He liked his Affordable Care Act plan and believes in it. He's still hoping Congress makes a deal. Not everyone, he says, has a best friend they can marry to get affordable health insurance.
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