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Health Insurance Coverage Among Same-Sex vs Different-Sex Couples.

Benjamin J Harrell1, Nicole E Jones2, Gabe H Miller3,4

  • 1Department of Economics, Trinity University, San Antonio, Texas.

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Health insurance coverage for same-sex couples has improved, reaching parity with different-sex couples. However, these gains are not equitable across all income levels or states without Medicaid expansion.

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Area of Science:

  • Health Services Research
  • Sociology
  • Public Health Policy

Background:

  • The Patient Protection and Affordable Care Act and the Obergefell v. Hodges ruling aimed to reduce health disparities.
  • Historically, lesbian, gay, bisexual, and/or transgender (LGBT) individuals faced significant health insurance disparities.
  • Recent trends suggest a potential reversal of these disparities, but equitable access remains a concern.

Purpose of the Study:

  • To analyze health insurance coverage differences between same-sex and different-sex couples.
  • To investigate how marital status, sex, insurance provider, state of residence, and income influence coverage.
  • To assess the impact of recent policy changes on LGBT health insurance parity.

Main Methods:

  • Cross-sectional study using secondary data analysis of the American Community Survey (ACS) from 2008-2022.
  • Inclusion of adults aged 18-64 in cohabitating relationships.
  • Linear probability models to assess the association between same-sex couple status and insurance coverage.

Main Results:

  • Individuals in same-sex couples were more likely to have employer-sponsored insurance but less likely to have public insurance.
  • Lower income quintiles in same-sex couples showed decreased insurance likelihood compared to higher quintiles.
  • Same-sex couples in states without Medicaid expansion had lower coverage rates.

Conclusions:

  • Health insurance coverage for same-sex couples has improved, reversing historical disparities.
  • Gains in coverage are concentrated among higher socioeconomic status individuals.
  • Further efforts are needed to ensure equitable insurance access across all income levels and states, particularly those that have not expanded Medicaid.