New York's marriage equality act associated with increase in health insurance coverage for same-sex couples

Implementation of New York's Marriage Equality Act in 2011 is associated with substantial increases in employer-sponsored health insurance and smaller reductions in state-funded Medicaid assistance for men and women in same-sex relationships, according to a study published by JAMA.

This study is being released online first because of the Supreme Court ruling on same-sex marriage.

When states recognize same-sex marriage, some workplaces are required to offer employer-sponsored health insurance (ESI) to married same-sex couples. On July 24, 2011, New York State began licensing same-sex marriages under the state's Marriage Equality Act, and at least 12,280 marriage licenses were issued to same-sex couples in the following 18 months, according to background information in the article.

Gilbert Gonzales, M.H.A., of the University of Minnesota, Minneapolis, examined the association between legalizing same-sex marriage in New York and changes in health insurance coverage using data from the 2008-2012 American Community Survey. This is a nationally representative mail survey conducted annually by the U.S. Census Bureau, with a sample size of approximately 3 million housing units and a 97 percent response rate. This survey does not ascertain sexual orientation; same-sex couples were identified when the primary respondent identified another person of the same sex as a husband, wife, or unmarried partner. The primary respondent reports current health insurance status for each household member.

This analysis included 2,848 adults in same-sex relationships and 228,470 adults in opposite-sex relationships (20 percent vs 55 percent had children, respectively; 63 percent vs 39 percent had college degrees). Both groups had parallel trends in ESI coverage until the implementation of same-sex marriage; ESI coverage increased significantly among adults in same-sex relationships in 2012. Compared with men in opposite-sex relationships, same-sex marriage was associated with a 6.3 percentage point increase in ESI 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.

"The U.S. Supreme Court will soon determine whether states are required to recognize same-sex marriages. Based on New York's experience, a favorable decision may extend access to ESI to lesbian, gay, bisexual, and transgender couples," the author writes.