Love In The Time Of Repeal And Replace

"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, N.Y., standing 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, and a bad cold that waylaid another. They're determined to tie the knot this afternoon. So they recruited their landlord from downstairs and a public radio reporter to be witnesses.

Why the rush? Boyer and Justi have 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 and Vitamin B-12 malabsorption — and the insurance she carried over from her previous job will expire this summer. She had employer-based insurance for more than a decade, but was laid off last year.

Justi and Boyer knew they could wait until the spring to get married, and she then could go on the health plan he receives as a concierge for a residential building — it's a union job, and the health insurance is good. But Boyer worries about Republicans unspooling crucial Obamacare safeguards.

"There's so much uncertainty as far as what's going to be law tomorrow, what's going to be law next month," he says. "Nobody really knows, unfortunately."

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 preexisting conditions, or charge them more for their insurance. As of now, the GOP bill in front of Congress also has language requiring that people with preexisting conditions be able to get health insurance.

But there are other factors that could make that insurance much more expensive — such as the applicant's age and the lack of a mandate, under the GOP plan, that everyone have health insurance. If you get rid of the mandate, many health care analysts say, it's likely that the people buying that insurance would mostly be sick — further driving up the cost of the insurance, and driving out of the insurance pool the healthy, younger people who tend to bring down the cost of the insurance.

Justi's current situation of having temporary insurance with an expiration date — instead of being on a stable health plan that can't kick her off — takes her 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 says.

So Justi and Boyer decided to get legally married as soon as possible, and have a more ceremonial, celebratory wedding in the fall. They found Rabbi Andy Dubin online, on a list of licensed local wedding officiants. They warmed to his profile, even though neither is Jewish.

The service in their living room is casual but formal. Dubin wears a suit, and both bride and groom are fashionably attired in black. Boyer sports a white rose boutonnière. Justi holds a bouquet 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 says.

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 give each other rings. Dubin declares, "By the authority vested me by state of NY, I now pronounce you, Don and Ann, husband and wife."

They kiss, then 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 who are 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, N.Y, hotel. They say they're prepared to face whatever comes next together –- in sickness and in health.

This story is part of NPR's reporting partnership with WNYC and Kaiser Health News. Fred Mogul has been covering health care and medicine for WNYC since 2002.

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