HEALTH: DO SAME-SEX MARRIAGE BANS NEGATIVELY IMPACT HEALTH CARE COVERAGE?

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HEALTH:

FOR RICHER OR POORER, IN SICKNESS AND IN HEALTH

DO SAME-SEX MARRIAGE BANS

NEGATIVELY IMPACT HEALTH CARE

COVERAGE?

UCLA

28 June 09

NINEZ PONCE, MPP, PHD 1

SUSAN COCHRAN, PHD, MS 2,4

VICKIE MAYS, PHD, MSPH 1,3

1.

2.

3.

4.

Department of Health Services

Department of Epidemiology

Department of Psychology

Department of Statistics

AcademyHealth Annual Meeting,

Chi IL

Background

Employer-based health insurance (EBHI) main source of healthcare coverage

Dependent EBHI coverage generally accrues through marriage

Sexual minorities are disadvantaged

This has both individual and potential societal costs

This Study

Objective

 To determine the effect of sexual orientation on health insurance status for nonelderly adults in

California

Notably

 Study focuses on sexual orientation and health insurance consequences for a single state

 Predates the short period in California when same-sex marriage was legal

 Stratifies by gender

Data Source

Exclusions

CHIS 2001, 2003, 2005

Sexual orientation Q’s

Population-based, RDD

Conducted in 5 languages

Racial/Ethnic

Oversamples

Interviews conducted by proxy

Respondents not reporting sexual orientation

Respondents 65 and older

Final Sample

N=110,254

63,719 females

46,535 males

Methods

Outcome

 Current Health Insurance Status

 Categories of: Uninsured, Privately-purchased, Public,

Employer-based own, Employer-based dependent

Predictors

 Regressor of Interest

 Sexual Orientation Status: Gay or Lesbian compared to

Heterosexual

 Other control variables

 Race/ethnicity, Age, Income, Education, Citizenship,

Partnership Status, Minor Children, Language of Interview,

Rural/Urban Labor Characteristics, Health Status

Methods

Statistical Analysis

 Weighted multivariate multinomial logit models:

 Full sample (all nonelderly adults)

 Only partnered/married adults

 All models stratified by gender

 Computed predicted probabilities and relative risks

 Gays/lesbians relative to heterosexuals

 Bootstrapped 95% CIs

Sexual Orientation and

Partnered/Marital Status

48%

36%

8%

48%

3%

Women

56%

62%

36%

2%

Men

57%

36%

7% Not Married or

Partnered

Partnered

Married

Health Insurance Status:

Comparing Gay Males with Heterosexual Males

Sample size

All Males

46,535

Partnered/Married

29,057

Uninsured

Public

Own EBHI

Dep EBHI

Direct Purchase

Relative Risk [95% CI] Relative Risk [95% CI]

0.88 [0.59, 1.02]

1.21 [0.96, 1.55]

1.03 [0.96, 1.14]

0.78 [0.49,1.08]

1.07 [0.86, 1.25]

1.45 [1.07, 1.93]*

1.91 [1.21, 2.71]*

0.93 [0.80, 1.00]

0.51 [0.34,0 .71]*

1.16 [0.63, 1.65]

*p<0.05 CHIS 2001, 2003, 2005; bootstrapped CIs controlling for Race/ethnicity, Age, Income, Education, Citizenship, Minor Children,

Language of Interview, Rural/Urban ,Labor Market Characteristics, Health Status

Health Insurance Status:

Comparing Lesbians with Heterosexual

Females

Sample size

Uninsured

Public

Own EBHI

Dep EBHI

Direct Purchase

All Females

63,719

Partnered/Married

38,195

Relative Risk [95% CI] Relative Risk [95% CI]

1.39 [1.00, 1.81]* 1.99 [1.43, 2.76]*

0.95 [0.72, 1.41]

0.98 [0.78, 1.11]

0.90 [0.52, 1.33]

0.82 [0.60, 1.11]

2.06 [1.01, 3.35]*

1.27 [1.08, 1.48]*

0.32 [0.19, 0.44]*

0.98 [0.72, 1.51]

*p<0.05 ; CHIS 2001, 2003, 2005; bootstrapped CIs controlling for Race/ethnicity, Age, Income, Education, Citizenship, Minor Children,

Language of Interview, Rural/Urban ,Labor Market Characteristics, Health Status

Summary

Among cohabiting/married nonelderly adults, gay men and lesbians are more likely to be uninsured than their heterosexual counterparts

 Due to a much lower likelihood of receiving dependent EBHI

Partnered sexual minorities are also more likely to depend on public insurance than heterosexual counterparts

Limitations

Low survey response rate

Telephone administration introduces nonresponse bias but addressed in weighted analysis

Wage/fringe benefit tradeoff not determined

Inability to differentiate unmarried but partnered couples into those that were registered civil unions/domestic partnerships and those that were not

Conclusions

Bans on same-sex marriages lead to EBHI disadvantages among gays and lesbians

Lower EBHI dependent coverage drives the disadvantage and appears to levy a toll on publically-financed health systems and raise the risk of uninsurance

Implications

Employers who discriminate are less efficient and lost efficiency threatens competitiveness and solvency

(Becker, 1971)

Disadvantage stems from how EBHI is offered and taxed –so has implications for upcoming changes in insurance

Same-sex marriage ban and its effects on

EBHI akin to “middle class” tax on

EBHI—and this study saw negative impact on coverage

UCLA

Thank

Y

QUESTIONS AND

COMMENTS

National Institute of Drug Abuse (DA 15539, DA 20826), the National

Center for Minority Health and Health Disparities (MD000508), the

National Cancer Institute, K07 CA100097

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