Funded by a grant from the RobertWood Johnson Foundation
State Variation in Health Insurance
Coverage Among Same-Sex Coupl...
Background: Who are same-sex couples?
• Sexual minorities
Lesbian, Gay & Bisexual (LGB)
• Partnered
Married
Civil Union
Do...
States differ in their policies on same-sex couples
3
Source: National Conference of State Legislatures
Why does marriage matter?
• Most Americans are covered through a family
member’s employer health plan
 “Legal” spouse
 D...
The role of employers
Large employers (500+ employees) offering same-sex domestic partner
benefits
5
12%
16%
19%
21%
24%
2...
Federal barriers to coverage
• Employee Retirement Income Security Act (ERISA)
 Health insurance coverage is mandated for...
What are the outcomes?
• Men and women in same-sex couples are less
likely to have health insurance
BRFSS (Buchmueller & C...
What are the outcomes?
• Men and women in same-sex couples are less
likely to have health insurance
BRFSS (Buchmueller & C...
Methods
1. National-level disparities
2. Adjusted state-level disparities in ESI
3. Adjusted disparities in ESI by state m...
GLB Population in the ACS
• Same-sex spouses / unmarried partners
10
Control Variables & Outcomes
• Educational attainment
• Age
• Sex
• Race
• Employment
• Hours Worked
• Industry
• Own chil...
Limitations to the ACS
• Missing Information
• Sexual orientation and gender identity
• Health status
• Firm size
• Source...
Economic Characteristics
48%
71%
5% 4%
34%
77%
5%
8%
18%
68%
10%
13%
≥ College Degree Full-Time
Employment
Unemployment In...
Demographic Characteristics
20%
77%
5%
12% 12%
18%
70%
8%
15%
50%
43%
63%
14%
19%
40%
Age 25-34 White Black Hispanic Minor...
Disparities in Insurance: Men
Compared to married men in opposite-sex relationships
15
Adjusts for race/ethnicity, age, em...
Disparities in Insurance: Women
Compared to married women in opposite-sex relationships
16
0.49
0.64
0.90
1.09
0.00
0.20
0...
Where are the coverage gaps in ESI?
17
Coverage Gaps in ESI
Men in SS relationships vs. Married Men in OS Relationships
18
RD: 0-10%
RD: > 10%
Same-sex couples
e...
Coverage Gaps in ESI
Women in SS relationships vs. Married Women in OS relationships
19
RD: 0-10%
RD: > 10%
Same-sex coupl...
Does state marriage policy
modify coverage gaps?
20
MEN in Same-Sex Relationships
21
Compared to living in states without provisions
• Same-Sex Marriage: +1.45% (p>0.10)
• Ci...
WOMEN in Same-Sex Relationships
22
Compared to living in states without provisions
• Same-Sex Marriage: +3.84% (p<0.01)
• ...
Summary
• Men and women in same-sex couples are less
likely to be insured through an employer
nationwide
• Largest ESI cov...
Policy Implications
• Potential for states to require fully insured
employers to extend benefits to same-sex
spouses
• Emp...
Sign up to receive our newsletter and updates at
www.shadac.org
@shadac
Gilbert Gonzales, MHA
Doctoral Student
Graduate Re...
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Pres paa apr12_gonzales

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Pres paa apr12_gonzales

  1. 1. Funded by a grant from the RobertWood Johnson Foundation State Variation in Health Insurance Coverage Among Same-Sex Couples Gilbert Gonzales, MHA Population Association of America New Orleans, LA April 12, 2013
  2. 2. Background: Who are same-sex couples? • Sexual minorities Lesbian, Gay & Bisexual (LGB) • Partnered Married Civil Union Domestic Partnership Unmarried, but cohabitating 2
  3. 3. States differ in their policies on same-sex couples 3 Source: National Conference of State Legislatures
  4. 4. Why does marriage matter? • Most Americans are covered through a family member’s employer health plan  “Legal” spouse  Dependent children 4 Example: University of Minnesota, Office of Human Resources
  5. 5. The role of employers Large employers (500+ employees) offering same-sex domestic partner benefits 5 12% 16% 19% 21% 24% 27% 29% 34% 34% 39% 39% 46% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Source: 2011 Mercer National Survey of Employer-Sponsored Health Plans
  6. 6. Federal barriers to coverage • Employee Retirement Income Security Act (ERISA)  Health insurance coverage is mandated for same-sex spouses in 16 states, but state mandates only affect fully- insured employers (42% employees)  Self-insured employers are regulated by the federal government, not states • 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) 6 Source: Badget MVL. The economic value of marriage for same-sex couples. Drake Law Review. 2010.
  7. 7. 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) 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) • What can the American Community Survey tell us about national and regional disparities in health insurance coverage? 8
  9. 9. Methods 1. National-level disparities 2. Adjusted state-level disparities in ESI 3. Adjusted disparities in ESI by state marriage policy 9
  10. 10. GLB Population in the ACS • Same-sex spouses / unmarried partners 10
  11. 11. Control Variables & Outcomes • Educational attainment • Age • Sex • Race • Employment • Hours Worked • Industry • Own child in household • Citizenship 11 • Health Insurance • Employer-Sponsored Insurance (ESI) • Individual • Medicare • Medicaid • Uninsured
  12. 12. 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 12
  13. 13. Economic Characteristics 48% 71% 5% 4% 34% 77% 5% 8% 18% 68% 10% 13% ≥ College Degree Full-Time Employment Unemployment In Poverty Same-Sex Couples Married Opposite-Sex Couples Unmarried Opposite-Sex Couples 13
  14. 14. Demographic Characteristics 20% 77% 5% 12% 12% 18% 70% 8% 15% 50% 43% 63% 14% 19% 40% Age 25-34 White Black Hispanic Minor Child in Household Same-Sex Couples Married Opposite-Sex Couples Unmarried Opposite-Sex Couples 14
  15. 15. Disparities in Insurance: Men Compared to married men in opposite-sex relationships 15 Adjusts for race/ethnicity, age, employment, industry, income, region, citizenship, minor child, survey year Source: American Community Survey, 2008-2010. * indicates p<0.05 0.58 0.75 1.31 1.04 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Employer Individual Medicaid Medicare * * *
  16. 16. Disparities in Insurance: Women Compared to married women in opposite-sex relationships 16 0.49 0.64 0.90 1.09 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 Employer Individual Medicaid Medicare Adjusts for race/ethnicity, age, employment, industry, income, region, citizenship, minor child, survey year Source: American Community Survey, 2008-2010. * indicates p<0.05 * *
  17. 17. Where are the coverage gaps in ESI? 17
  18. 18. Coverage Gaps in ESI Men in SS relationships vs. Married Men in OS Relationships 18 RD: 0-10% RD: > 10% Same-sex couples equal or better off Adjusts for race/ethnicity, age, employment, industry, income, region, citizenship, minor child, survey year Source: American Community Survey, 2008-2010. RD=relative difference.
  19. 19. Coverage Gaps in ESI Women in SS relationships vs. Married Women in OS relationships 19 RD: 0-10% RD: > 10% Same-sex couples equal or better off Adjusts for race/ethnicity, age, employment, industry, income, region, citizenship, minor child, survey year Source: American Community Survey, 2008-2010. RD=relative difference.
  20. 20. Does state marriage policy modify coverage gaps? 20
  21. 21. MEN in Same-Sex Relationships 21 Compared to living in states without provisions • Same-Sex Marriage: +1.45% (p>0.10) • Civil unions or domestic partnerships: +1.66% (p>0.10) Adjusts for race/ethnicity, age, employment, industry, income, region, citizenship, minor child, survey year Source: American Community Survey, 2008-2010
  22. 22. WOMEN in Same-Sex Relationships 22 Compared to living in states without provisions • Same-Sex Marriage: +3.84% (p<0.01) • Civil unions or domestic partnerships: +3.00% (p<0.01) Adjusts for race/ethnicity, age, employment, industry, income, region, citizenship, minor child, survey year Source: American Community Survey, 2008-2010
  23. 23. Summary • Men and women in same-sex couples are less likely to be insured through an employer nationwide • Largest ESI coverage gaps located in the South for men and in the Midwest for women • Living in a state with same-sex marriage, civil unions or domestic partnerships is associated with increased levels of ESI for women in same-sex relationships 23
  24. 24. 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 a strategy to attract employees • Repealing DOMA could remove barriers to coverage for same-sex couples 24
  25. 25. Sign up to receive our newsletter and updates at www.shadac.org @shadac Gilbert Gonzales, MHA Doctoral Student Graduate Research Assistant gonza440@umn.edu University of Minnesota School of Public Health Division of Health Policy & Management

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