State Variation in Health InsuranceCoverage Among Same-Sex CouplesGilbert GonzalesGender and Health Interest Group Meeting...
Background: Who are same-sex couples?• Sexual minorities     Gay, Lesbian, Bisexual, Transgender (GLBT)• Partnered     Mar...
States differ in their policies on same-sex couples                                                      3
Why does marriage matter?• Most Americans are covered through a family  member’s employer health plan         “Legal” spo...
The role of employersLarge employers (500+ employees) offering same-sex domestic partnerbenefits                          ...
Improvements vary by regionSame-sex domestic partner coverage among large employers (500+ employees)                      ...
Federal barriers to coverage   • Defense of Marriage Act (DOMA)           Does not recognize same-sex unions at the feder...
What are the outcomes?• Men and women in same-sex couples are less  likely to have health insurance     BRFSS   (Buchmuell...
What are the outcomes?• Men and women in same-sex couples are less  likely to have health insurance     BRFSS   (Buchmuell...
Methods1. Multinomial Logit: Marginal Effects     Yij = α + β1Maritali + βiXi + ε2. State-Level Coverage Estimates3. Cover...
GLB Inclusion in the American Community Survey• Same-sex spouses / unmarried partners• What is an unmarried partner?  An “...
Control Variables & Outcomes•   Educational attainment   • Health Insurance•   Age                         • Employer-Spon...
Limitations to the ACS• Missing Information     •   Sexual orientation and gender identity     •   Health status     •   F...
Larger sample size compared to previous studiesNon-elderly adults in same-sex relationships                               ...
Economic Characteristics                    66%                         Same-Sex Couples                          62%     ...
Demographic Characteristics                                         Same-Sex Couples               77%                  71...
Marginal Effects: Men    Compared to married men in opposite-sex relationships     16%                      6%            ...
Marginal Effects: Women    Compared to married women in opposite-sex relationships     16%                      6%        ...
State Variation in Insurance Coverage(Public & Private) among Same-Sex Couples                                            19
Coverage Gaps in Insurance CoverageCompared to Married Opposite-Sex Couples                                           20
State Variation in ESI Coverage                                  21
Coverage Gaps in ESICompared to Married Opposite-Sex Couples                                           22
Uninsurance over the Life Continuum            50%            45%            40%                              Same-Sex Cou...
ESI over the Life Continuum                               80%                              Same-Sex CouplesEmployer-Sponso...
Summary• Men and women in same-sex couples are  roughly 10% less likely to be insured through  an employer• Same-sex coupl...
Policy Implications• Potential for states to require fully insured  employers to extend benefits to same-sex  spouses• Emp...
Gilbert Gonzales, MHA        Doctoral Student   Graduate Research Assistant       gonza440@umn.edu        University of Mi...
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Pres shrpig june23_gonzales

  1. 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. 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. 3. States differ in their policies on same-sex couples 3
  4. 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. 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. 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. 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. 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. 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. 10. Methods1. Multinomial Logit: Marginal Effects Yij = α + β1Maritali + βiXi + ε2. State-Level Coverage Estimates3. Coverage Across the Life Continuum 10
  11. 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. 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. 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. 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. 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. 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. 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. 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. 19. State Variation in Insurance Coverage(Public & Private) among Same-Sex Couples 19
  20. 20. Coverage Gaps in Insurance CoverageCompared to Married Opposite-Sex Couples 20
  21. 21. State Variation in ESI Coverage 21
  22. 22. Coverage Gaps in ESICompared to Married Opposite-Sex Couples 22
  23. 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. 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. 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. 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. 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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