1. The right to equal standards of healthcare, regardless of marital status.
THE PROBLEM: Clinicians often hesitate to provide single people with more intensive treatments (which often are more advanced and effective treatments), because they believe single people don’t have a support system, or because they believe single people don’t have “as much to live for.” During the COVID-19 pandemic, many single people reported fearing for their lives, due to openly stated rhetoric that married patients and patients with (nuclear) families had more to live for and therefore deserved ventilators more. This jibes with research by Drs. DePaulo and DelFattore showing the dangers of physician prejudice against single people.
2. The right to equal access to health, bereavement, other benefits in the workplace and from commercial industries, and the right to designate use of family leave benefits outside the conventional (nuclear-based) definition of family.
THE PROBLEM: Single workers are often given more difficult tasks, longer hours, or inconvenient travel jobs.[i] They are often expected to cover holidays and have the last choice of vacation times. Although this discrimination is technically illegal, employers are not held accountable for this behavior, because the belief that singles are less-than is ingrained in society. Single employees commonly get less bereavement leave and less family and medical leave. Spouses who are on their partner’s health insurance policy have more career and employment flexibility: They can take jobs that offer no insurance or less fulsome insurance. A single person, who does not have the option of piggybacking on anyone’s insurance, doesn’t have this same flexibility. Many companies offer additional payments, often several thousand dollars, to employees who elect not to participate in the employer’s health care plan—once again favoring married people who have more options for health insurance beyond the company’s offerings.
The Family and Medical Leave Act (FMLA) allows employees to take up to twelve weeks of unpaid leave to care for ill or disabled family members—but only family members within strictly-defined nuclear-family parameters, primarily based around a spouse. According to the Department of Labor website, FMLA “is designed to help employees balance their work and family responsibilities. . .” However, the DoL’s limited definition of “family” excludes many or most of single people’s loved ones, thereby further upsetting single people’s work-family balance—ironically so, given that single employees are usually asked to pick up the slack of their married co-workers, whose work-life balance is seen to be more worthy of protection.
The DoL website also states that the FMLA’s goal is to “promote equal employment opportunity for men and women.” Ironically, the FMLA widens the resource and employment gaps between men and women. In addition to their families (and corresponding life choices) not being respected and validated, single people are also paid less money than are married people. Combine that with the fact that singlism historically has disproportionally harmed, and continues to disproportionally harm, single women (especially single women of color or disabled single women) more than men.
3. The right to visitation, in any health-related facility (including hospice or other institutions related to dying) from non-spousal/non-nuclear loved ones.
THE PROBLEM: Hospital staff often won’t allow a single person’s non-spousal or non-nuclear-adjacent support people into the patient’s room without explicit consent from bio-legal kin or medical power of attorney. Since 2011, according to federal law[ii], patients in any hospital that accepts Medicare or Medicaid (the majority of hospitals) have the right to say who their visitors can and should be. However, staff may not be aware of this policy,[iii] so they may assume only nuclear-adjacent persons should be allowed to see the patient (HIPAA law states that if you can’t give consent regarding your visitors, providers can decide whom they share your information with, if anyone). The patient may also be in the care of a private institution that is not required to follow the 2011 federal law or has active policies limiting visitors to those in the spousal/nuclear rubric.
4. The right to pay for a reliable transportation service to and from all medical procedures.
THE PROBLEM: Medical facilities whose treatments require anesthesia or other function-impeding procedures sensibly require patients to have a designated person arrive at the facility (and often, wait during the entire procedure) in order to escort them home, but the patient may well not be allowed to arrange a taxi if none of their support people are available (a policy that also impacts married people whose spouse has other unavoidable obligations). Business and marketing strategist Cathy Goodwin explains why this is a problem[iv]: The medical establishment doesn’t trust her to arrange a ride home, but it trusts her not to eat before anaesthesia, where a slip-up could kill her. A patient might be new in a community. Medical transport services are expensive and/or for Medicaid patients. Friends may not be able to take time off work.
5. The right to equal access to and costs of healthcare.
THE PROBLEM: Single people incur higher costs for healthcare than do married people, for myriad reasons, many of which are detailed elsewhere in this bill of rights. Significant financial discrimination against singles occurs in the health insurance industry. This is partly because singles are seen as more irresponsible and less healthy, even though there are often problems with the relevant studies supposedly supporting this notion.[v]
Spouses who are on their partner’s health insurance policy have more career and employment flexibility: They can take jobs that offer no insurance or less fulsome insurance. A single person, who does not have the option of piggybacking on anyone’s insurance, doesn’t have this same flexibility. The public healthcare insurance marketplace, due to its expense and lack of comprehensive plans, does not always fill this gap for single people—and especially not for single people with disabilities or chronic health conditions.
6. The right to equal treatment and compensation when disabled, regardless of marital status.
THE PROBLEM: Across all facets of society, disability rights and benefits are heavily tied to marital status. Some single disabled people will lose benefits if they get married. Some single disabled people cannot afford to live alone on their disability benefits, and they may therefore be forced to augment their expenses by entering into unappealing, toxic, or abusive marriages or cohabitations. According to the U.S. General Accounting Office’s 1997 list of marriage laws[vi], a federal civil service employee who is ‘disabled by work-related injuries receives augmented compensation if he or she is married.’
Social Security Income (SSI) benefits are tightly tied to marital status, mostly to the detriment of single people. Although two married people receiving SSI will receive somewhat less money than if they were each single (which is itself an unfair practice), a single person receiving SSI will always receive less income than a married couple who is receiving SSI. What’s more, married people are allowed to have more assets than single people, before they are not eligible for SSI.[vii] This inequity becomes even more impactful for single people with disabilities who can’t supplement their healthcare expenses by piggy-backing on a spouse’s healthcare plan.
Social Security Disability (SSDI) eligibility is based on how much a disabled person has earned when they were working—or how much their spouse or parent earned/earns. Disability advocate Dr. Jill Summerville explains that this setup is residue from when women were socioeconomically dependent on men, and a married person (woman) was seen as being an “adult,” but a single person (woman) wasn’t. Dr. Summerville points out that in SSDI law, SSDI benefits acquired via marriage are more solid (easier to hold onto) than SSDI benefits acquired from parents—for no reason other than that marriage is seen as an accomplishment worthy of reward.[viii] Although of course historically all women, including married women, have been denied personhood to large degrees, disabled women are particularly denigrated. Dr. Summerville explains:
Wifehood has been presented as a desirable and socially acceptable form of female dependency. By contract, disabled women have not historically been presented as desirable, and unlike an able-bodied wife’s, their dependence on sociocultural or socioeconomic resources is not heralded as a celebrated milestone in reaching adulthood.[ix]
SSI benefits are closely tied to whether recipients also receive Medicaid. Disabled people comprise fifteen percent of Medicaid recipients.[x] Therefore, any SSI, SSDI, or Medicaid policies that disenfranchise people based on marital status disproportionately disenfranchise disabled people—especially disabled people who fall into the “Medicaid Gap.”[xi] Those are people whose incomes are below the federal poverty level but not low enough to qualify for Medicaid. Because single people make less money, and disabled people make less money, disabled or ill single people are more likely to inhabit this gap.
Medicare privileges married people even when they are no longer married. For example, divorced people may be eligible for premium-free Medicare Part A through their ex-spouse.
7. The right to refuse to answer, or to not be asked, clinical intake questions about one’s marital status.
THE PROBLEM: Clinicians often hesitate to provide single people with more intensive treatments (which often are more advanced and effective treatments), because they believe single people don’t have a support system. This erroneous belief is reflected in new patient intake forms. They almost always ask whether a patient is married, and patients are usually required to answer. There are other reasons why these forms may ask about marital status: in most jurisdictions a spouse may be held liable for their romantic partner’s bills, or in case of emergency or situations requiring decisions about direct care, the clinic needs to know the patient’s legal “closest relative.” However, a couple of factors indicate that these intake questions are influenced by unconscious bias more than practicality: in practicality: 1) Most intake forms do not ask for specific spousal contact information, only marital status; and 2) when pressed, clinicians almost always say the question tells them whether a patient has a support network.[xii]
8. The right to protection from having one’s mental or physical health pathologized, based on marital status.
THE PROBLEM: The health industrial complex often presumes that single people lack a support system. For this reason, and because of the stereotype of singles as lonely, health providers and workers commonly assume that single people’s mental health is impacted by their romantic relationship status.[xiii] This presumption is not only likely to be inaccurate[xiv] in many cases (evidence suggests that on average, single people are more connected in their communities, and to more and diverse networks of people, than are married people[xv]), but it may also distract healthcare workers from legitimate sources of emotional distress in the single patients’ lives.
[i] Todd, Sarah. “More people are staying single-and workplaces need to adjust.” Quartz, 09 November 2021, qz.com/work/2086874/why-more-people-are-staying-single-and-how-workplaces-can-adjust (Accessed: 20250311)
[ii] “FAQS on Patient Visitation at Certain Federally Funded Entities and Facilities.” U.S. Department of Health and Human Services: Civil Rights. https://www.hhs.gov/civil-rights/for-individuals/special-topics/emergency-preparedness/faqs-patient-visitation/index.html (Accessed 20250202, per WayBack Machine: web.archive.org/web/20250131091446/https://www.hhs.gov/civil-rights/for-individuals/special-topics/emergency-preparedness/faqs-patient-visitation/index.html)
Basic information about the new visitation rights can also be found here:
“Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions of Participation To Ensure Visitation Rights for All Patients.” Federal Register, 19 November 2010, www.federalregister.gov/documents/2010/11/19/2010-29194/medicare-and-medicaid-programs-changes-to-the-hospital-and-critical-access-hospital-conditions-of (Accessed: 20250312)
[iii] DelFattore, Joan, Ph.D. “In a Hospital, Friends Are Not People.” Medium, 01 September 2020, joandelfattore.medium.com/in-a-hospital-friends-are-not-people-7bd3b69b3b7a (Accessed: 20250311)
[iv] Goodwin, Cathy. “How Hospital Do Us Wrong: Am I getting surgery, or joining a country club?” Guest post on DePaulo’s Living Single, 26 March 2016, www.psychologytoday.com/us/blog/living-single/201603/how-hospitals-do-us-wrong (Accessed: 20250311)
[v] DePaulo, Bella. “Getting Married and (Not) Getting Healthy: What Decades of Research Really Shows.” BellaDepaulo.com, 28 December 2013, belladepaulo.com/2013/12/getting-married-and-not-getting-healthy-what-decades-of-research-really-shows/ (Accessed 20250729)
[vi] “Categories of Laws Involving Marital Status.” General Accounting Office, Office of the General Counsel, 31 January 1997, buddybuddy.com/gao-1997.pdf (Accessed: 20250309)
[vii] Summerville, Jill, PhD. “Single Women with Disabilities, Part 1: Guest Post by Dr. Jill Summerville.” Medium, Fourth Wave, Bella DePaulo, 01 March 2022, medium.com/fourth-wave/single-women-with-disabilities-part-1-guest-post-by-jill-summerville-c66bd78e8bb2 (Accessed: 20250309)
[viii] Summerville, Jill, PhD. “Single Women with Disabilities, Part 2.” Medium, Fourth Wave, Bella DePaulo, 06 March 2022, medium.com/fourth-wave/single-women-with-disabilities-part-2-guest-post-by-jill-summerville-27c74bf7a297
[ix] Dr. Jill Summerville, informal email communications with the author, 20250609
[x] “Medicaid Provides Health Coverage for People with Disabilities.” Medicaid.gov, www.medicaid.gov/about-us/program-history/medicaid-50th-anniversary/entry/47691 (Accessed: 20250309)
[xi] “The Medicaid Coverage Gap: State Fact Sheets.” Medicaid.gov, 03 April 2024, www.cbpp.org/research/health/the-medicaid-coverage-gap (Accessed: 20250309)
[xii] DePaulo, Bella and Joan DelFattore. “Stop asking people whether they’re married—even as an icebreaker.” Quartz, 21 September 2017, qz.com/1083162/heres-why-you-should-stop-asking-people-whether-theyre-married-even-as-an-icebreaker (Accessed: 20250312)
[xiii] DePaulo, Bella. “Therapy and the Single Person.” BellaDePaolo.com, 04 June 2018, belladepaulo.com/2018/06/therapy-single-person (Accessed: 20250312)
[xiv] DePaulo, Bella. “What’s Wrong with Studies and Claims about the Supposed Benefits of Marriage?” BellaDePaulo.com, 28 July 2018, belladepaulo.com/2018/07/whats-wrong-studies-claims-supposed-benefits-marriage (Accessed: 20250312)
[xv] DePaulo, Bella. “The Social Lives of Single People.” Psychology Today, 17 May 2019, www.psychologytoday.com/us/blog/living-single/201905/the-social-lives-single-people (Accessed: 20250312)
Singles Equality | Singles Bill of Rights 