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Suppose you and your spouse each have great jobs with excellent health insurance. But your spouse decides to go back to school to pursue new interests and maybe make more of a difference in the world. This doesn’t sound that unusual; a few readers may think it selfish, but most would agree it’s a reasonable venture. Now suppose your spouse has health concerns that aren’t adequately being addressed even with that excellent insurance. Oh, goodness—what a challenge! Or is it? If you’re fortunate enough to have family coverage at work, that would cover your spouse’s health care; no big deal.

Now suppose that spouse is in fact an unmarried partner. You are a gay couple in which one member wants to go back to school. And the individual who continues to work cannot cover the partner because his employer doesn’t cover that. Does it still sound reasonable, or a selfish whim?

My partner and I are in that situation, and the helplessness I felt, being unable to provide something which seemed so basic. I’ve only felt that helpless once before, when he fell on a business trip and called me from an ambulance; at least then, I knew he had good insurance and coworkers were there to help him out. As a computer programmer, I would have looked for work in the private sector where domestic partner coverage is not unusual, but he insisted we find another solution.

My partner also has a physical disability. He has never let it limit him, despite its increased effect on his mobility with age. But life without insurance coverage, or with insurance that excludes pre-existing conditions, is unthinkable to us. A sprain, a fall, or a problem with his medication pump, are more likely to impact him severely and require professional care.

Even when employed, his insurance wouldn’t pay for a wheelchair because it wasn’t needed to “get around the house”, as if full employment and life activities for people with disabilities limited them to home. Buying a wheelchair with cash instead of insurance actually reduced the price that was charged. (An aside: while sports medicine enhances and recovers the slightest technical limitations of athletes, and clinics for children with disabilities appear in the media and at local health care providers, adults with disabilities are expected to settle for smaller improvements.) Physical therapy is often limited to a certain number of visits per year, and even then, is only approved if “the condition is expected to improve”.

But let’s go back to school. A returning adult student has a couple of options. Continuing to work while going to school; relying on coverage from a spouse or partner; going without insurance; buying a student health plan; buying some other plan on their own; or going without insurance. The first three weren’t feasible. Nor was the fourth, when the details were examined: the student health plan not only charged higher premiums for older students, but failed to cover prescription medications (including pump refills) at a realistic level. That left the last option—not very attractive to someone with a congenital disability. A state-mandated high-deductible plan ended up being the plan of choice.

We’ve paid from $10,000-$15,000 annually for this coverage, between premiums, deductible, and co-pays, and I know we’re getting a good deal, and we’re fortunate to be able to spend that. There’s the occasional wrestling with misdirected bills, prior authorizations, incorrectly coded procedures, and drug formularies, but that’s apparently the norm. We have the fortitude and he has the technical background to resolve those efficiently.

No dental coverage is included, so I signed up for an employee-paid dental plan at work that included domestic partners or spouses. With its limitations and policies, I paid $500 in a year for coverage for the two of us (the plan duplicated coverage I already had). This paid for about $1,000 of dental care for him. Seeing the “Explanation of Benefits” statements arrive over one procedure was both amusing and sad: at least six exchanges occurred with the dentist, requesting records, notes, and before and after X-rays, all to ensure that the same tooth had not been treated for the same problem recently.

This issue is familiar to me. In 1996, I began tracking which Wisconsin employers provided domestic partners with any sort of benefit—sick leave, health insurance, even invitations to company events. My goal was to encourage more employers to provide such benefits and more employees to request them. I provided links to cost estimates and obscure tax topics. Feedback and questions I received, and continue to receive, indicate that it was a useful volunteer project that helped others.

In 2007, I found myself needing that kind of coverage myself, and it was not available.

But on January 1, 2010, my employer, the University of Wisconsin, will join the rest of the Big Ten schools in providing health insurance and other benefits to domestic partners of its employees. By then, my partner will hopefully be employed; but if not, I plan on enrolling him, even though I’ll pay taxes on the value of the benefit, unlike married employees. Perhaps I should tout that as an advantage to those who think this coverage is undeserved: it actually increases tax collections from gay and lesbian employees. And besides, his dream job will likely be the one that doesn’t have the best benefits, but that helps the most people, and I’m happy to finally be able to support that.

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