Disparities in insurance and access to health care: New evidence from the national health interview survey, 1997-2011

Background Health disparities on the basis of sexual orientation have been recognized as a public health priority and targeted for elimination, yet research in lesbian, gay, bisexual and transgender (LGBT) health has largely ignored access to and utilization of health care services. Our study builds on previous research by testing (1) whether health insurance coverage and access to care have improved among the LGBT population over time and (2) whether the legal status of same-sex relationships reduces these disparities in coverage and access to care.

Methods We use data from the 1997-2011 National Health Interview Surveys to monitor disparities among nonelderly adults (18-64 years) in married same-sex relationships (N=614) and unmarried same-sex partnerships (N=4,221). We compared differences in insurance coverage between same-sex couples and different-sex couples over the recent decade and then estimated logistic regression models to evaluate whether being in a self-reported legal marriage improved health insurance coverage or access to health care.

Results Our analysis reveals that disparities in health insurance coverage and access to care have persisted between 1997 and 2011 despite greater recognition and protections for LGBT populations. Married and unmarried men (OR=0.3) and women (OR=0.2) in same-sex relationships were significantly less likely (p<0.05) to have health insurance coverage. Yet, only the adults in unmarried same-sex relationships were more likely to delay needed health care due to cost. Conclusion Our study provides early evidence that being in a married same-sex relationship may not improve access to health insurance, but may influence health care utilization patterns.