LGBT Insurance Disparities

Legal marriage for same-sex (SS) adults is currently recognized by 16 states and the District of Columbia. An additional 3 states grant civil unions, but the remaining states have banned SS marriage through legislative action or amendments to their state constitutions. These for SS couples or LGBT individuals. Previous studies have shown a decreased rate of insurance for SS couples when compared to opposite-sex (OS) relationships, but these studies had limited sample sizes. A new study published in the American Journal of Public Health used a general household survey conducted by the US Census Bureau to obtain a much larger sample size of SS and OS couples and compare rates.

Both men and women in SS relationships reported equal or higher levels of employment, income, and education, whereas women in unmarried OS relationships reported the lowest levels of income, education, and employment. However, after controlling for demographic and socioeconomic characteristics, individuals in SS relationships were significantly less likely than individuals in married OS relationships to have insurance through an employer. They were also less likely to directly purchase insurance from an insurance company or to obtain it through Medicare. They were more likely to have insurance through Medicaid or a government assistance program. States with legal SS marriage or civil unions had decreased disparities in employer-sponsored insurance between SS and OS couples.

However, state-level insurance mandates have not had the desired positive effect on insuring SS couples. The majority of employer-based insurance plans are self-insured plans, where the employer assumes the risk of health claims out of their own assets. These plans fall under federal law, and thus are not subject to state jurisdiction. Additional roadblocks include laws that tax the employer contribution to health insurance when a SS partner is added.

Commentary

Separate from any religious belief, the social infrastructure in which our relationships are defined and/or protected directly impacts our access to health care on an individual basis. While those who are anti-same sex marriage often argue that it has a direct impact on their own relationships and the status of marriage in society, this article sheds light on the actual financial impact that denying SS marriage/civil unions/domestic partnerships can bring about—which is potentially a stronger argument. Our government spends more money through government assistance programs because we do not let these individuals marry. Finally, there exists a budgetary and fiscal responsibility argument for marriage equality!

Gonzalez, G. and Blewett, L. AJPH. 2014; 104 (2): 95 – 104.

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Kameron Matthews, MD, JD