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  • 1. Disparities in Health Insurance for Children with Same-Sex Parents Gilbert Gonzales, MHA Lynn A. Blewett, PhD University of Minnesota American Academy of Pediatrics National Conference Council on Foster Care, Adoption and Kinship Care Orlando, FL October 28, 2013 Funded by a grant from the Robert Wood Johnson Foundation
  • 2. Disclosure I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity 2
  • 3. Health Insurance Important for Children’s Health • Health insurance for children leads to better health, reduced mortality • Health insurance coverage for children remains a major public policy goal Source: Levy & Meltzer (2008). “The Impact of Health Insurance on Health”, Annual Review of Public Health. 3
  • 4. More children raised by gay and lesbian parents 48% Lesbian women; 20% Gay men under 50: Raising children <18 125,000 (19%) same-sex households raising 220,000 children Children with same-sex parents reside in every state, but face various family policies Source: Gates G (2013). LGBT Parenting. The Williams Institute. 4
  • 5. 14 states + DC allow same-sex marriage Source: National Conference of State Legislatures 5
  • 6. Why does marriage matter? • Most Americans are covered through a family member’s employer health plan  “Legal” spouse  Dependent children Example: University of Minnesota, Office of Human Resources 6
  • 7. 21 states allow second parent adoptions statewide Source: Human Rights Campaign 7
  • 8. American Academy of Pediatrics Endorses second-parent adoptions in 2002 8
  • 9. American Academy of Pediatrics Backlash from pediatricians 9
  • 10. American Academy of Pediatrics Endorses same-sex marriage in 2013 10
  • 11. What does this mean for the modern gay family? 11
  • 12. What does this mean for the modern gay family? Mitchell Cameron Lily 12
  • 13. What does this mean for the modern gay family? Mitchell Cameron Lily UNINSURED INSURED 13
  • 14. In a state w/o marriage or 2nd parent adoptions Mitchell Cameron Lily UNINSURED INSURED Legal adoption UNINSURED 14
  • 15. In a state w/o marriage but with 2nd parent adoptions Mitchell Cameron Lily UNINSURED INSURED Legal adoption Legal adoption INSURED 15
  • 16. In a state with marriage and with 2nd parent adoptions Mitchell Legal marriage, Civil Unions, Broad Domestic Partnerships Cameron Lily INSURED INSURED Legal adoption Legal adoption INSURED 16
  • 17. Research Questions • Are children with same-sex parents less likely to have private health insurance? • Do state policies modify private health insurance coverage for children with same-sex parents? 17
  • 18. American Community Survey, 2008-2010 • Health insurance added in 2008 – – – – – Employer-Sponsored Insurance (ESI) Directly Purchased / Individual Medicare Medicaid Uninsured • Large sample size! – 3 million people each year – Supports state level research – Leading data resource for same-sex couples 18
  • 19. GLB Population in the ACS • Same-sex spouses / unmarried partners 19
  • 20. GLB Population in the ACS • Children of same-sex parents 20
  • 21. Limitations to the ACS • Missing Information • • • • • Sexual orientation Married vs. Unmarried Health status Firm size Source of coverage (own ESI or dependent) • Missing Same-Sex Couples • If identified as roommates or unrelated adults • If neither is the respondent • Missing LGB singles • Missing Children of Same-Sex Couples • If residing in another home 21
  • 22. Methods: Multinomial logistic regression: Private, Public vs. Uninsured First, all children 0-17 years by family type • Opposite-sex parents, married (n=1,389,789) • Same-sex parents, dual fathers (n= 1,649) • Same-sex parents, dual mothers (n=3,432) Then, by state policy environment as of Jan 1, 2008 • Same-sex marriage & civil unions vs. no marriage provisions • Second-parent adoptions vs. no adoption provisions Controlling for:  Race/ethnicity, age, gender, citizenship, disability, relationship to reference parent of each child  Age of reference parent, parents’ combined income, work status of parent, highest educational attainment of parents, total number of children, primary language spoken at home 22
  • 23. Results 23
  • 24. Disparities in Insurance: Compared to children with married opposite-sex parents Dual Fathers Dual Mothers 1.6 Odds Ratio 1.4 1.13 1.2 1.05 1 0.8 0.6 0.55* 0.61* 0.4 0.2 0 Private Public Adjusts for race/ethnicity, age, gender, citizenship, disability, relationship to parent, age of reference parent, parents’ combined income, parents’ work status, highest educational attainment of parents, total number of children, primary language spoken at home, state and survey year. Source: American Community Survey, 2008-2010. * indicates p<0.05 24
  • 25. Disparities in Private Health Insurance: Compared to children with married opposite-sex parents Dual Fathers Odds Ratio 1.2 Dual Mothers 1 0.8 0.6 0.62 * 0.6 * 0.4 0.2 0 Private States without marriage provisions Adjusts for race/ethnicity, age, gender, citizenship, disability, relationship to parent, age of reference parent, parents’ combined income, parents’ work status, highest educational attainment of parents, total number of children, primary language spoken at home, state and survey year. Source: American Community Survey, 2008-2010. * indicates p<0.05 25
  • 26. Disparities in Private Health Insurance: Compared to children with married opposite-sex parents Dual Fathers Odds Ratio 1.2 Dual Mothers 1 0.8 0.6 0.81 0.62 * 0.6 * 0.43 * 0.4 0.2 0 Private States without marriage provisions Private States with marriage provisions Adjusts for race/ethnicity, age, gender, citizenship, disability, relationship to parent, age of reference parent, parents’ combined income, parents’ work status, highest educational attainment of parents, total number of children, primary language spoken at home, state and survey year. Source: American Community Survey, 2008-2010. * indicates p<0.05 26
  • 27. Disparities in Private Health Insurance: Compared to children with married opposite-sex parents Dual Fathers Odds Ratio 1.2 Dual Mothers 1 0.8 0.6 0.49* 0.60 * 0.4 0.2 0 Private States without second-parent adoptions Adjusts for race/ethnicity, age, gender, citizenship, disability, relationship to parent, age of reference parent, parents’ combined income, parents’ work status, highest educational attainment of parents, total number of children, primary language spoken at home, state and survey year. Source: American Community Survey, 2008-2010. * indicates p<0.05 27
  • 28. Disparities in Private Health Insurance: Compared to children with married opposite-sex parents Dual Fathers Odds Ratio 1.2 Dual Mothers 1 0.8 0.6 0.49* 0.60 * 0.71 0.65 0.4 0.2 0 Private States without second-parent adoptions Private States with second-parent adoption Adjusts for race/ethnicity, age, gender, citizenship, disability, relationship to parent, age of reference parent, parents’ combined income, parents’ work status, highest educational attainment of parents, total number of children, primary language spoken at home, state and survey year. Source: American Community Survey, 2008-2010. * indicates p<0.05 28
  • 29. Key Findings • Children with same-sex parents are less likely to be covered by private health insurance • Disparities in private health insurance diminish when children live in states with legal same-sex marriage, civil unions or second-parent adoptions • Findings support AAP policy statement in favor of second-parent adoptions & same-sex marriage 29
  • 30. For more information: October Issue 30
  • 31. Gilbert Gonzales, MHA Doctoral Student Graduate Research Assistant gonza440@umn.edu University of Minnesota School of Public Health Division of Health Policy & Management Sign up to receive our newsletter and updates at www.shadac.org @shadac