The Impact of Same-Sex Marriage on Health Insurance Coverage: Evidence from Four States
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1 The Impact of Same-Sex Marriage on Health Insurance Coverage: Evidence from Four States Gilbert Gonzales, MHA University of Minnesota Association for Public Policy Analysis & Management Policy Research on Same-Sex Marriage Saturday, November 9, 2013
2 Click Background to edit Master title style Click Same-sex to edit Master couples text are styles less likely to have health insurance, especially through employers NHIS (Heck et al. 2006) CPS (Ash & Badget, 2006) BRFSS (Buchmueller & Carpenter, 2010) ACS (Gonzales & Blewett, 2014) 2
3 Click Most Americans to edit Master are title covered style through a family member s employer health plan Legal spouse Dependent children 3
4 Employers Click to edit often Master required title to extend style benefits to same-sex spouses after same-sex marriage Source: National Conference of State Legislatures 4
5 Click Research to edit Question Master title style What Second is the level effect of same-sex marriage on health Third insurance level coverage among same-sex couples? 5
6 American Click to edit Community Master title Survey, style Click Health to edit insurance Master text added styles in 2008 Second Employer-Sponsored level Insurance (ESI) Third Directly level Purchased / Individual Medicare Medicaid Uninsured Large sample size! 3 million people each year Supports state level research Leading data resource for same-sex couples 6
7 Difference-in-Differences Click to edit Master title style (DD) Analysis Click Pre-Post to edit research Master design text styles Target group: Same-sex couples in 4 states (CT, IA, NH, VT) Comparison groups unaffected by policy change 1) married opposite-sex couples in same state 2) same-sex couples in neighboring states Linear probability models controlling for: Race/ethnicity, age, income, educational attainment, employment status, industry, related child in household, citizenship, state fixed effects Separate models for: State with no provisions adopting marriage (IA) States replacing civil unions/domestic partnerships with marriage (CT, NH, VT) 7
8 Difference-in-Differences Click to edit Master title style (DD) Analysis Y i = Second β 0 + βlevel 1 Treat + β 2 Post + β 3 Treat*Post + X i + ε 8
9 Difference-in-Differences (DD) From No Provisions to Same-Sex Marriage Click to edit Master title style 12.0% 10.0% 8.0% 6.0% 4.0% + 8.2% + 9.3% 2.0% 0.0% Men Women Comparison Group 1: Married Opposite-Sex Couples in Iowa Adjusts for race/ethnicity, age, employment, industry, income, state, citizenship, minor child. Source: American Community Survey, * indicates p<0.05 9
10 Difference-in-Differences (DD) From No Provisions to Same-Sex Marriage Click to edit Master title style 12.0% 10.0% 8.0% 6.0% + 8.2% + 9.3% + 7.7% + 9.6% 4.0% 2.0% 0.0% Men Women Men Women Comparison Group 1: Married Opposite-Sex Couples in Iowa Comparison Group 2: Same-Sex Couples Neighboring Iowa Adjusts for race/ethnicity, age, employment, industry, income, state, citizenship, minor child. Source: American Community Survey, * indicates p<
11 Difference-in-Differences (DD) From Civil Unions to Same-Sex Marriage Click to edit Master title style 8.0% + 7.6% * 6.0% 4.0% 2.0% 0.0% -2.0% 0.1% Gay Men Lesbian Women Comparison Group 1: Married Opposite-Sex Couples in CT, NH, VT Adjusts for race/ethnicity, age, employment, industry, income, state, citizenship, minor child. Source: American Community Survey, * indicates p<
12 Difference-in-Differences (DD) From Civil Unions to Same-Sex Marriage Click to edit Master title style 8.0% + 7.6% * + 7.5% * 6.0% 4.0% 2.0% 0.0% -2.0% 0.1% Men -1.4% Men Women Women Comparison Group 1: Married Opposite-Sex Couples in CT, NH, VT Comparison Group 2: Same-Sex Couples Neighboring CT, NH, VT Adjusts for race/ethnicity, age, employment, industry, income, state, citizenship, minor child. Source: American Community Survey, * indicates p<
13 Click Key Findings to edit Master title style 1) Second Same-sex level marriage leads to ~7.5% increase in health insurance coverage for women in same-sex relationships 2) Limited evidence that same-sex marriage improved health insurance coverage in Iowa or for men 3) Detectable gains in coverage by replacing civil union laws with legal same-sex marriage 13
14 Click to Gilbert edit Master Gonzales, title style MHA PhD Student Graduate Research Assistant University of Minnesota School of Public Health Division of Health Policy & Management
15 Click Discussion to edit Master title style 15
16 GLB Population in the ACS Click to edit Master title style Same-sex spouses / unmarried partners 16
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