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Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
Pres shrpig june23_gonzales
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Pres shrpig june23_gonzales

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  • 1. State Variation in Health InsuranceCoverage Among Same-Sex CouplesGilbert GonzalesGender and Health Interest Group MeetingOrlando, FLJune 23, 2012 Funded by a grant from the Robert Wood Johnson Foundation
  • 2. Background: Who are same-sex couples?• Sexual minorities Gay, Lesbian, Bisexual, Transgender (GLBT)• Partnered Married Civil Union Domestic Partnership Unmarried, but cohabitating 2
  • 3. States differ in their policies on same-sex couples 3
  • 4. 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 4
  • 5. The role of employersLarge employers (500+ employees) offering same-sex domestic partnerbenefits 39% 39% 34% 34% 29% 27% 24% 21% 19% 16% 12% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Source: 2011 Mercer National Survey of Employer-Sponsored Health Plans 5
  • 6. Improvements vary by regionSame-sex domestic partner coverage among large employers (500+ employees) 64% 59% 2009 52% 2010 49% 39% 39% 28% 26% 27% 24% All large West Midwest Northeast South employers Source: 2011 Mercer National Survey of Employer-Sponsored Health Plans 6
  • 7. Federal barriers to coverage • Defense of Marriage Act (DOMA)  Does not recognize same-sex unions at the federal level  Insurance for same-sex spouses treated as taxable income (adds $1,000 annually) • Employee Retirement Income Security Act (ERISA)  Self-insured employers are regulated by the federal government, not states  Health insurance coverage is mandated for same-sex spouses in 16 states, but state mandates only reach fully-insured employers (42% private employees)Source: Badget MVL. The economic value of marriage for same-sex couples. Drake Law Review. 2010. 7
  • 8. What are the outcomes?• Men and women in same-sex couples are less likely to have health insurance BRFSS (Buchmueller & Carpenter, 2010) CPS (Ash & Badget, 2006) NHIS (Heck et al., 2006) 8
  • 9. What are the outcomes?• Men and women in same-sex couples are less likely to have health insurance BRFSS (Buchmueller & Carpenter, 2010) CPS (Ash & Badget, 2006) NHIS (Heck et al., 2006)• What can the American Community Survey tell us about national and regional disparities in health insurance coverage? 9
  • 10. Methods1. Multinomial Logit: Marginal Effects Yij = α + β1Maritali + βiXi + ε2. State-Level Coverage Estimates3. Coverage Across the Life Continuum 10
  • 11. GLB Inclusion in the American Community Survey• Same-sex spouses / unmarried partners• What is an unmarried partner? An “unmarried partner,” also known as a domestic partner, is a person who shares a close personal relationship with Person 1. 11
  • 12. Control Variables & Outcomes• Educational attainment • Health Insurance• Age • Employer-Sponsored Insurance (ESI)• Sex • Individual• Race • Medicare• Employment • Medicaid• Hours Worked • Uninsured• Industry• Own child in household• Citizenship 12
  • 13. Limitations to the ACS• Missing Information • Sexual orientation and gender identity • 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 13
  • 14. Larger sample size compared to previous studiesNon-elderly adults in same-sex relationships 17,420 16,235 Men Women 2,881 2,384 316 298 486 478 NHIS CPS BRFSS ACS 1997-2003 1996-2003 2000-2007 2008-2010 Heck et al. 2006 Ash & Badget 2006 Buchmueller & Gonzales, forthcoming Carpenter 2010 14
  • 15. Economic Characteristics 66% Same-Sex Couples 62% Married Opposite-Sex Couples 52% Unmarried Opposite-Sex Couples 45% 33% 21% 15% 8% 9% 8% 5% 4%≥ College Degree Full-Time Unemployment In Poverty Employment 15
  • 16. Demographic Characteristics Same-Sex Couples 77% 71% Married Opposite-Sex Couples 66% Unmarried Opposite-Sex Couples 23% 25%25% 17% 17% 14% 12% 11% 11% 7% 8% 7% Age 55-65 White Black Hispanic Minor Child in Household 16
  • 17. Marginal Effects: Men Compared to married men in opposite-sex relationships 16% 6% Employer 1% 1% 0% Uninsured Individual Medicaid -8% Same-Sex Couples -16%Controls: Race/ethnicity, age, employment, industry, income,region, citizenship, minor child, survey year 17
  • 18. Marginal Effects: Women Compared to married women in opposite-sex relationships 16% 6% 6% Employer 1% 0% Uninsured Individual Medicaid -9% Same-Sex Couples -16%Controls: Race/ethnicity, age, employment, industry, income,region, citizenship, minor child, survey year 18
  • 19. State Variation in Insurance Coverage(Public & Private) among Same-Sex Couples 19
  • 20. Coverage Gaps in Insurance CoverageCompared to Married Opposite-Sex Couples 20
  • 21. State Variation in ESI Coverage 21
  • 22. Coverage Gaps in ESICompared to Married Opposite-Sex Couples 22
  • 23. Uninsurance over the Life Continuum 50% 45% 40% Same-Sex Couples 35% Married Opposite-Sex CouplesUninsured 30% 25% 20% 15% 10% 5% 0% 20 30 40 50 60 70 80 90 Age 23
  • 24. ESI over the Life Continuum 80% Same-Sex CouplesEmployer-Sponsored Insurance 70% Married Opposite-Sex Couples 60% 50% 40% 30% 20% 10% 0% 20 30 40 50 60 70 80 90 Age 24
  • 25. Summary• Men and women in same-sex couples are roughly 10% less likely to be insured through an employer• Same-sex couples have lower rates of coverage than married, opposite-sex couples in all but 7 states• Across the life continuum, partnered sexual minorities are less likely than their married peers to be covered by an employer 25
  • 26. Policy Implications• Potential for states to require fully insured employers to extend benefits to same-sex spouses• Employers can voluntarily expand coverage to same-sex spouses as strategy to attract employees• Repealing DOMA could remove barriers to coverage for same-sex couples 26
  • 27. Gilbert Gonzales, MHA Doctoral Student Graduate Research Assistant gonza440@umn.edu University of Minnesota School of Public HealthDivision of Health Policy & ManagementSign up to receive our newsletter and updates at www.shadac.org @shadac

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