Academic journal article Contemporary Economic Policy

Separate and Unequal: The Effect of Unequal Access to Employment-Based Health Insurance on Same-Sex and Unmarried Different-Sex Couples

Academic journal article Contemporary Economic Policy

Separate and Unequal: The Effect of Unequal Access to Employment-Based Health Insurance on Same-Sex and Unmarried Different-Sex Couples

Article excerpt

I. INTRODUCTION

For most nonelderly people in the United States, health insurance and access to health care derive from one's own or a family member's employment. As a matter of customary compensation practice, many employers offer employment-based health insurance to spouses of employees. Gay, lesbian, or bisexual (GLB) people are at a significant disadvantage in this route to health insurance, however, because they cannot legally marry in the United States and are unable to claim benefits for a same-sex domestic partner from most employers. Employees who have a different-sex unmarried partner are at a similar disadvantage with respect to employment benefits, although they have the option of marrying. This article assesses the consequences of compensation inequality for GLB people's insurance status and for people with different-sex unmarried partners, as well as the impact of more equitable policies on those individuals and their employers. Although the health insurance issue plays a central role in debates about the appropriate legal status of same-sex couples, we link questions about benefits for same-sex partners to unmarried different-sex partners because the two kinds of couples have been linked ethically, politically, and institutionally in the debate about employer benefits.

Because 80% of nonelderly insured people in the United States receive coverage through their own employment or through the employment-based health insurance of a family member (U.S. Bureau of the Census, 2002), the exclusion of domestic partners makes unmarried couples and their children likely to lack insurance at a rate higher than the 14% U.S. average for the nonelderly (U.S. Bureau of the Census, 2002). No study has yet established how much access to health insurance is limited because of the structure of employee benefits, but three reports suggest that rates of being uninsured may be significantly higher for GLB people, in particular. One study pooled data from seven nonrandom surveys of lesbian and bisexual women and determined that lesbians were less likely to have health insurance than were a similar sample of women in the National Health Interview Survey (Cochran et al., 2001). A second study using data from 1992 voter exit polls found that only 29% of heterosexual but 46% of GLB voters said that they "presently do not have health insurance" (Badgett, 1994). Third, a study of women in the Los Angeles County found that lesbian and bisexual women were significantly less likely to have health insurance, even after controlling for employment status, age, income, and education (Diamant et al., 2000). Finally, a 2002 nationwide probability sample of men and women aged 15-44 also showed that gay men and bisexual women were much more likely to report no current health insurance coverage than were their heterosexual counterparts (Mosher et al., 2005). Our study starts by measuring insurance disparities across sexual orientation but goes beyond the existing literature by including people with unmarried different-sex partners and by assessing the likely contribution of employer compensation practices to the sexual orientation insurance disparity.

In spite of the obvious health policy concerns raised by the lack of insurance for people with unmarried partners, regardless of sexual orientation, policy makers and many employers have most commonly addressed the issue of domestic partner benefits from the perspective of civil rights for GLB people. First, as employers themselves, many cities, counties, and states have adopted the practice of providing benefits to the domestic partners of GLB people and often to heterosexual employees' unmarried partners, as well (Badgett, 2001). A 2004 survey found that the practice has spread to the private sector, with 14% of firms offering health-care coverage to same-sex domestic partners, and 12% of firms offering coverage to different-sex partners (Kaiser Family Foundation and Health Research and Educational Trust, 2004). …

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