Fractured insurance families: securing care and navigating financialized social protections

Health insurance products mediate intimate relations of care in the United States where access to insurance is predicated on income, disability, age, immigration status, and family composition. This study of insurance enrolment experiences under the Affordable Care Act health reform law explores how applicants attempted to strategically naturalize their kin arrangements by applying for health insurance together. Applicants navigated ambiguity around who was part of their family and how to protect one another against health and financial risk within a policy landscape that expanded the definition of family to include married same sex couples, offered new protections to middle and high income families, and exposed low income and immigrant families to additional administrative burdens. These life histories demonstrate how caring through finance can both fracture and naturalize kin relations as people try to match their lived families to governmental eligibility categories in order to access health benefits. The ACA broadened inclusion in financialized instruments of social protection for some, even as it reproduced exclusions that make health insurance more difficult to attain for many immigrants, family formations that deviate from the standard of a married household with biological children, and for people with unpredictable and low incomes.