National and State-Specific Health Insurance Disparities among Adults in Same-Sex Relationships: Results from the American Community Survey

Gilbert Gonzales, University of Minnesota

Most adults receive health insurance through their own or through a family member's employer-sponsored insurance (ESI) plan, but same-sex couples face additional federal and state barriers to enrolling spouses onto ESI. This paper examines national and state-specific disparities in insurance coverage among adults in same-sex relationships. Adjusted and unadjusted relative differences in ESI coverage were estimated using predictive margins on 31,947 adults in same-sex relationships from the 2008-2010 American Community Survey (ACS) — making this the largest study of insurance coverage among same-sex couples and the first to compare state-specific disparities. ESI disparities among adults in same-sex relationships were found in every region after controlling for demographic and economic factors, but the largest gaps in ESI were found among men in the South and women in the Midwest. ESI disparities among women in same-sex relationships diminished in states that had extended legal same-sex marriage, civil unions, and broad domestic partnerships.