The Gay Health Insurance Gap

The national debate about marriage equality for same-sex couples highlights troubling questions about health insurance. For many gay activists, access to a partner's employer-provided health care coverage is a call-to-arms. For some activists on the left, though, winning coverage just for same-sex partners through marriage smacks of unfair treatment that excludes unmarried heterosexual couples and other nontraditional families. It looks like a dilemma for progressives: Would righting one injustice mean reinforcing another one?

Fortunately, the answer is no, although both sides of the progressive debate make important points -- there are big holes in our country's health care system. Using new data on unmarried couples, my fellow economist Michael Ash and I found that 20 percent of people with same-sex partners are uninsured, almost twice the rate of married couples. Worse yet, one-third of people with heterosexual unmarried partners lack insurance coverage.

So are gay marriage activists abandoning their unmarried heterosexual counterparts in a quest for marital privilege in the form of cheaper doctor visits? Not according to the numbers. Instead, same-sex couples who marry would end up in the same precarious position that straight married couples face with regard to health insurance. Although married couples have better access to health insurance than the average American, more than 10% of married people remain uninsured, too.

Furthermore, over the last two decades, gay, lesbian, and bisexual people have led a minor workplace revolution that gained domestic partner benefits for many more unmarried partners of heterosexual employees than gay ones. Complete victory in the workplace would not mean the end of the insurance gap, however. Even if all employers gave domestic partners the same benefits married workers get, 14 percent of people in same-sex couples and 21 percent in different-sex couples would still go uninsured.

Clearly patching a few holes in the fairness of the system won't fix it. Equal benefits for unmarried couples -- and even for other kinds of family relationships -- would simply reveal more ugly truths about our health care system's dependence on employers, who are increasingly getting out of the costly health insurance game. In addition to marriage equality, we need serious health care reform that will delink insurance from jobs and marriage and make coverage universal.

But some queer activists and their allies on the left have also argued in last summer's well-publicized "Beyond Same-Sex Marriage" statement that gay organizations' focus on marriage is a perversion of priorities. According to this argument, funneling resources to the marriage equality effort siphons off resources better spent on building support for large-scale policy changes that would benefit people in all kinds of families as well as single people. Fortunately, the evidence suggests that there's enough political energy and activism to go around.

Some of the states with the most successful marriage equality movements are also the leaders in health care reform. Vermont, Massachusetts, and California aren't just three of the first states to recognize same-sex couples' right to marriage or another kind of partnership recognition. They're the three states with recent legislation that would provide universal coverage for state residents through a single payer plan (Sen. Sheila Kuehl's bill in California, unfortunately vetoed by the governor) or would significantly expand subsidized coverage for uninsured people in other ways (Vermont and Massachusetts). Connecticut, the first state to enact civil unions by legislation and home of a well-organized marriage equality effort, subsidizes health insurance for families with kids whose family incomes are up to 300 percent of the poverty level.