Massive gap in partner benefits produces lack of health insurance

by on June 25, 2010  •  In Employment law, Health, Social science

A new study documents the harsh impact on lesbians and gay men of the absence of partner benefits in employer-sponsored health insurance (ESI). Through the mid-2000's in California, less than one-third (28%) of partnered lesbians received "dependent" coverage from ESI, a differential that resulted in the fact that among all partnered or married women, lesbians were twice as likely to lack health insurance as heterosexual women. Among partnered or married men, less than half (42%) of partnered gay men received "dependent" coverage from ESI. Although there was no gap based on sexual orientation in employed persons receiving their own health coverage, the magnitude of the shortfall in partner benefits produced a gay/straight differential in overall health insurance coverage.

The study – The Effects Of Unequal Access To Health Insurance For Same-Sex Couples In California by Ninez A. Ponce, Susan D. Cochran, Jennifer C. Pizer and Vickie M. Mays – has been published online by Health Affairs; the study will also appear in the journal’s August issue. Health Affairs is the leading health policy journal in the U.S. There is free access to the full article until July 8. Ponce, Cochran, and Mays are on the faculty at UCLA; Jenny Pizer is senior counsel and director of the marriage project at Lambda Legal in Los Angeles.

This study is the first to quantify the gap between dependent coverage received by heterosexual employees and that received by lesbian and gay employees, and to quantify the greater extent to which the dependent partners of lesbian and gay employees are uninsured.

The study sample was drawn from results of the California Health Interview Survey in 2001, 2003, and 2005. As a result, most of the data were collected before full implementation of the California Insurance Equality Act of 2005, which requires employers that offer spousal benefits to also extend benefits to registered domestic partners. (Employers that offer self-funded ERISA plans – 31% of CA employers – are exempt from the state law; but two-thirds of the exempt employers had voluntarily extended partner benefits as of 2009). The authors expect that the 2005 California law as well as the national Patient Protection and Affordable Care Act may serve to alleviate some of the disparities documented by this study. They also found, however, that the way government agencies and employers define “dependents” and the federal taxation of health benefits for a same-sex spouse or partner continue to be “a relevant underlying structural determinant of whether or to what extent sexual-orientation minorities will have more equal access to employer-sponsored insurance.” Achieving universal coverage, they conclude, depends, in part, on “remedying inequalities in state and federal marriage-related rules.”

In the study sample, 51% of lesbians and 38% of gay men reported being in a partnered or married relationship, compared to 64% of both female and male heterosexuals. Other studies have found that half of cohabiting lesbian couples in CA and about a quarter of cohabiting gay male couples have registered as partners under the state's law.

There are many more fascinating details available if one reads the full study. It brings home the point of how important it is to analyze data both now and after the insurance mandate and the availabiliy of exchanges become nation-wide realities in 2014. Will exchanges, for example, essentially eliminate this differential? Even if the differential disappears, will there still be a quality gap between the coverage that is available through an exchange and what is available to partners of an individual insured at his/her workplace? Cutting the other way, will the fact that securing a policy through an exchange will not require coming out, as is implicitly part of the process when an employee secures coverage for a partner, make that route more appealing to LGB persons?  Could both dynamics result, perhaps with geographic differentials?

Kudos to the authors for this terrific study!


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