Same-Sex Marriage and Gains in Employer-Sponsored Insurance for US Adults, 2008–2017

Abstract

Objectives. To estimate the effects of same-sex marriage recognition on health insurance coverage. Methods. We used 2008–2017 data from the American Community Survey that represent 18 416 674 adult respondents in the United States. We estimated changes to health insurance outcomes using state–year variation in marriage equality recognition in a difference-in-differences framework. Results. Marriage equality led to a 0.61 percentage point (P = .03) increase in employer-sponsored health insurance coverage, with similar results for men and women. Conclusions. US adults gained employer-sponsored coverage as a result of marriage equality recognition over the study period, likely because of an increase in dependent coverage for newly recognized same-sex married partners.