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Pres appam nov9_gonzales Presentation Transcript

  • 1. The Impact of Same-Sex Marriage on Health Insurance Coverage: Evidence from Four States Gilbert Gonzales, MHA University of Minnesota Association for Public Policy Analysis & Management Policy Research on Same-Sex Marriage Saturday, November 9, 2013
  • 2. Background Click to edit Master title style Same-sex couples styles Click to edit Master textare less likely to have health insurance, especially through employers Second level Third level NHIS level (Heck et al. 2006) Fourth Fifth level CPS (Ash & Badget, 2006) BRFSS (Buchmueller & Carpenter, 2010) ACS (Gonzales & Blewett, 2014) 2
  • 3. Most to edit Master covered through a Click Americans are title style family member’s employer health plan Click to edit Master text styles  Second level “Legal” spouse  Dependent children Third level Fourth level Fifth level 3
  • 4. Employersedit Master title style benefits to Click to often required to extend same-sex spouses after same-sex marriage Click to edit Master text styles Second level Third level Fourth level Fifth level Source: National Conference of State Legislatures 4
  • 5. Click to edit Master title style Research Question Click to edit Master text styles Second level What is the effect of same-sex marriage on Third level health insurance coverage among same-sex Fourth level couples? Fifth level 5
  • 6. American edit Master title style Click to Community Survey, 2008-2011 Healthedit Master text styles in 2008 Click to insurance added • Employer-Sponsored Insurance (ESI) Second level • Directly Purchased / Individual Third level Fourth level • Medicare Fifth • Medicaidlevel • Uninsured Large sample size! • • • 3 million people each year Supports state level research Leading data resource for same-sex couples 6
  • 7. Difference-in-Differences style Analysis Click to edit Master title (DD) Pre-Post research design Click to edit Master text styles • Target group: Same-sex couples in 4 states (CT, IA, NH, VT) Second level • Comparison groups unaffected by policy change Third level opposite-sex couples in same state 1) married Fourth level 2) same-sex couples in neighboring states Fifth level Linear probability models controlling for: • Race/ethnicity, age, income, educational attainment, employment status, industry, related child in household, citizenship, state fixed effects Separate models for: • State with no provisions adopting marriage (IA) • States replacing civil unions/domestic partnerships with marriage (CT, NH, VT) 7
  • 8. Difference-in-Differences style Analysis Click to edit Master title (DD) Click to edit Master text styles Yi = β0 + β1Treat + β2Post + β3Treat*Post + Xi + ε Second level Third level Fourth level Fifth level 8
  • 9. Difference-in-Differences (DD) From No Provisions totitle style Marriage Click to edit Master Same-Sex Click to edit Master text styles 12.0% Second level 10.0% 8.0% 6.0% + 9.3% + 8.2% Third level Fourth level Fifth level 4.0% 2.0% 0.0% Men Women Comparison Group 1: Married Opposite-Sex Couples in Iowa Adjusts for race/ethnicity, age, employment, industry, income, state, citizenship, minor child. Source: American Community Survey, 2008-2011. * indicates p<0.05 9
  • 10. Difference-in-Differences (DD) From No Provisions totitle style Marriage Click to edit Master Same-Sex Click to edit Master text styles 12.0% Second level 10.0% 8.0% 6.0% + 9.6% + 9.3% + 8.2% Third level + 7.7% Fourth level Fifth level 4.0% 2.0% 0.0% Men Women Comparison Group 1: Married Opposite-Sex Couples in Iowa Men Women Comparison Group 2: Same-Sex Couples Neighboring Iowa Adjusts for race/ethnicity, age, employment, industry, income, state, citizenship, minor child. Source: American Community Survey, 2008-2011. * indicates p<0.05 10
  • 11. From Civil Unions to Same-Sex Marriage Click to edit Master title style Difference-in-Differences (DD) Click to edit Master text styles Second level 8.0% 6.0% 4.0% + 7.6% * Third level Fourth level Fifth level 2.0% 0.1% 0.0% Gay Men Lesbian Women -2.0% Comparison Group 1: Married Opposite-Sex Couples in CT, NH, VT Adjusts for race/ethnicity, age, employment, industry, income, state, citizenship, minor child. Source: American Community Survey, 2008-2011. * indicates p<0.05 11
  • 12. From Civil Unions to Same-Sex Marriage Click to edit Master title style Difference-in-Differences (DD) Click to edit Master text styles Second level 8.0% 6.0% 4.0% + 7.6% * * + 7.5% Third level Fourth level Fifth level 2.0% Men -1.4% 0.1% 0.0% Men Women Women -2.0% Comparison Group 1: Married Opposite-Sex Couples in CT, NH, VT Comparison Group 2: Same-Sex Couples Neighboring CT, NH, VT Adjusts for race/ethnicity, age, employment, industry, income, state, citizenship, minor child. Source: American Community Survey, 2008-2011. * indicates p<0.05 12
  • 13. Key Findings Click to edit Master title style Click to edit Master text styles 1) Same-sex marriage leads to ~7.5% increase in health Second level insurance coverage for women in same-sex Third level relationships Fourth level Fifth level 2) Limited evidence that same-sex marriage improved health insurance coverage in Iowa or for men 3) Detectable gains in coverage by replacing civil union laws with legal same-sex marriage 13
  • 14. Click to Gilbert Gonzales, MHA edit Master title style Click to edit Master text styles PhD Student Second level Graduate Research Assistant Third level gonza440@umn.edu Fourth level Fifth level University of Minnesota School of Public Health Division of Health Policy & Management www.shadac.org @shadac
  • 15. Discussion Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level 15
  • 16. Click to edit Master title style GLB Population in the ACS • Same-sex spouses / unmarried Click to edit Master text styles partners Second level Third level Fourth level Fifth level 16