I take you to be my wife and insurance provider

Some people marry for love, some for companionship and others for status or money. Now comes another reason to get hitched: health insurance.

In a poll released last week, 7 percent of Americans said they or someone in their household decided to marry in the past year so they could get health care benefits via their spouse.

"It's a small number but a powerful result, because it shows how paying for health care is reflected not only in family budgets but in life decisions," said Drew E. Altman, president of the Kaiser Family Foundation, which commissioned the survey as part of its regular polling on health care.

On a broader scale, the survey found that health care costs outranked housing costs, rising food prices and credit card bills as a source of concern. Twenty-eight percent of those surveyed said they had experienced serious problems because of the cost of health care, compared with 29 percent who had problems getting a good job or a raise. Gasoline prices were the top economic worry, with 44 percent saying they had problems keeping up with increases at the pump.

A companion poll also detected an important shift among voters: Independents in particular say they are more concerned about reducing medical costs than about increasing the number of Americans with health insurance.

A Kaiser poll from February found that 37 percent of independents wanted the presidential candidates to address costs first, while 32 percent cited the problem of getting coverage for the 47 million uninsured.

But in the latest poll, 46 percent of independents said the candidates should deal with costs, and 25 percent said expanding coverage should come first.

"To appeal to independent voters, the candidates are increasingly going to have to frame health care as an economic issue," Altman said.

Among the three presidential candidates, Republican Sen. John McCain of Arizona has emphasized reducing costs ahead of expanding coverage. Of the two Democrats, Sen. Hillary Clinton of New York has stressed coverage for all, and Sen. Barack Obama of Illinois has talked about gradually expanding coverage while trying to better control costs.

Health care inflation has been rising at about twice the rate of economic growth. But with employer-based health insurance averaging $12,000 for family coverage and $4,500 for individuals, the public concern with costs is understandable. Nearly a fourth of Americans said they had decided to keep or change jobs in the last year because of health insurance.

What surprised researchers was that such costs had become a factor in marriage decisions. "We should have asked about divorce," said Altman, joking.

Those who cited health insurance as a factor in deciding to marry tended to have modest incomes. About 6 in 10 were in households making less than $50,000 a year, said Mollyann Brodie, who directs Kaiser's opinion research. They also were younger, with four in 10 between 18 and 34.

"We don't know a lot more about them," Brodie said. "Just that they answered that of all the reasons for getting married, [health insurance] was also a reason, was surprising."

The Kaiser polling, conducted April 3-13, surveyed a nationally representative sample of 2,003 adults, and has a margin of error 3 percentage points.

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