Disparities in Health Insurance at the Intersection of Race and Sexual Orientation

Background: Disparities in health care on the basis of race and sexual orientation have been targeted for elimination and recognized as a public health priority, but research at the intersections of race and sexual orientation are largely absent. Our study fills this gap by estimating differences in health insurance coverage among racial and ethnic minorities who also report being in a same-sex relationship.

Methods: We use data from the 2009-2011 American Community Survey on nonelderly adults (25-64 years) in self-reported same-sex relationships (n=32,744), married opposite-sex relationships (n=2,866,636), and unmarried opposite-sex relationships (n=268,298). We use relative risk ratios from multinomial logistic regression models to report differences in primary source of health insurance while controlling for key socioeconomic and demographic factors.

Results: Our analysis reveals that adults in same-sex relationships are not a homogenous group. Hispanic men (RRR=0.38), African American women (RRR=0.32), and American Indian/Alaskan Native (AIAN) women (RRR=0.37) in same-sex relationships were much less likely to have employer-sponsored health insurance (ESI) compared to their white counterparts in married opposite-sex and same-sex relationships. White men (RRR=1.42) and women (RRR=1.29) in same-sex relationships were more likely to be covered by Medicaid.

Conclusions. Disparities in health insurance coverage among adults in same-sex relationships vary across racial and ethnic identities. Because racial and ethnic minorities are concentrated in states not expanding Medicaid or legalizing same-sex marriage, disparities in health insurance may exacerbate over time. Efforts should be taken to ensure access to health care for these vulnerable populations.