More Health Coverage, And Perhaps More Health, For Same-Sex Couples

You know how it goes: You have the great joy of the wedding — or of the gay pride celebrations that followed the Supreme Court's marriage decision — and then the honeymoon's over and it's time to talk about the mundanities of stuff like (sigh) health insurance.

But still, it can be at least quietly pleasing to contemplate the many a newlywed who'll now qualify for insurance offered by their new spouse's employer. (And that on top of the several million people whose health insurance subsidies were just saved by the previous Supreme Court decision, on Obamacare.)

Not to rain on the weddings, but it's also likely that many employers' "domestic partner" benefits will go away. The picture is complex, but a study just out in JAMA finds that legalizing gay marriage does indeed increase employer-based health insurance coverage for same-sex partners. It looked at New York after gay marriage was legalized there in 2011, and more than 12,000 same-sex couples wed. From the press release:

Compared with men in opposite-sex relationships, same-sex marriage was associated with a 6.3 percentage point increase in ESI [employer-sponsored health insurance] and a 2.2 percentage point reduction in Medicaid coverage for men in same-sex relationships. Same-sex marriage was also associated with an 8.9 percentage point increase in ESI and a 3.9 percentage point reduction in Medicaid coverage for women in same-sex relationships vs women in opposite-sex relationships.

I asked the study's author, Gilbert Gonzales of the University of Minnesota, whether anyone had done a similar study in Massachusetts after our own pioneering legalization of gay marriage more than a decade ago. He replied by email:

The only Massachusetts study I'm familiar with is an American Journal of Public Health study that found potential improvements in gay and bisexual men's health after MA enacted same-sex marriage in 2003. There were significant reductions in mental health care visits and expenditures in the year after MA enacted same-sex marriage, which suggests broad public health benefits for LGBT people when states recognize same-sex marriage.

Another related study on health insurance coverage looked at the 2005 domestic partnership law in California, and found the law increased health insurance coverage among lesbian women relative to heterosexual women. There was no similar finding for gay men. The JAMA study suggests that legal same-sex marriage--rather than domestic partnerships--may improve coverage options for both men and women in same-sex relationships.

How many people in all may gain employer health insurance thanks to the Supreme Court ruling?

It's not totally clear, Gonzales says, "partly because the health insurance landscape has changed very quickly under the Affordable Care Act. The ACA now allows married same-sex couples to seek private health insurance together in the federal and state marketplaces."

He adds: "Meanwhile, after last week's same-sex marriage ruling, married LGBT workers will have more options to enroll a same-sex partner in employer health plans. This may help low-income same-sex couples in states not expanding Medicaid or where coverage options are more limited."

I also checked in with M.V. Lee Badgett, author of "When Gay People Get Married: What Happens When Societies Legalize Same-Sex Marriage." Her take: "The gap in health insurance coverage has been closing with the ACA, but marriage equality will help."

She, too, cites the Massachusetts study that linked legalizing same-sex marriage with health improvements. And on the new JAMA study she says it is "a simple one but well-done and has sensible results."

Further Reading:

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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