A recent study by two University of Minnesota researchers concludes that children of same-sex couples are less likely to have private health insurance than their peers with heterosexual parents.
The study found that differences in private insurance coverage is less substantial in states where same-sex marriage is legal.
Published in Pediatrics last week, University of Minnesota authors Lynn Blewett and Gilbert Gonzales found that 63.3 percent of children with dual fathers and 67.5 percent of children with dual mothers had private insurance. Those rates are much lower than the 77.5 percent of children with opposite-sex parents who have the same type of medical coverage. (The study did not break down numbers by individual states.)
Gonzales, who spearheaded the research, said that “for kids, studies are consistently finding that health insurance does improve health. So these policy barriers in states without same–sex marriage shows that passing these laws is a pathway to expanding health insurance, and in turn, improving the health and well-being of these kids.”
More than half of the U.S. population obtains their health insurance through their employer but only about 30 percent of employers nationwide extend these same benefits to gay or lesbian parents and their children, according to the study. In some cases, children of same-sex couples are not considered legal family members unless they are biologically or legally related through marriage or adoption.
Blewett said this gap in insurance coverage should be considered discrimination.
Complex laws and policies
With policies differing by employers, marital status and state laws, insurance for children of same-sex couples becomes increasingly convoluted, leaving many large-business owners to decide who they cover and who they exclude.
“Health insurance is weird because the rules are different depending on the size of the company,” said Eileen Smith, director of communications and public relations for the Minnesota Council of Health Plans. “Big entities like the University of Minnesota or 3M only have to follow federal laws when it comes to insurance benefits, so state laws do not apply to them. State laws only apply to mandates to coverage and waiting periods. And even some of the new provisions in the federal law don’t apply to those big companies.”
The University of Minnesota researchers note that disparities in health insurance coverage for children were reduced in states that allowed same-sex marriage, civil unions or second-parent adoptions (when an adoption by the secondary parent of the home who is not married to the legal parent is allowed.)
In Minnesota, the legalization of gay marriage as well as a general progressive mentality makes it easier for same-sex parents and their children to obtain private health insurance, said Amy Monahan, professor at the University of Minnesota Law School.
“Clearly, if the children are legally considered to be of the employee, then it isn’t generally an issue for them to get insurance,” she said.
But in states that do not allow same-sex marriage or second-parent adoptions, “the children [of same-sex parents] might not actually be considered children of the employee,” Monahan said. “Even though you have a family living together as a single unit, because they’re not considered a unit legally, they may not have access to private health insurance.”
In addition, due to having a two-person income, gay and lesbian parents often earn more than the state-sponsored health-insurance income limit, making their children ineligible for public coverage.
‘At the mercy of employers’
For Hannah Meacock Ross, a Minneapolis resident with two gay fathers, health-care and insurance issues have always pressed same-sex parents and their children.
“In my experience, a lot of [the laws] put families at the mercy of employers. Even though we have marriage in Minnesota, there’s actually a big story to be written about the relationship of parents and children to their insurance.”
Meacock Ross, who is 33 and has health insurance, said she believes that families with same-sex parents feel discrimination not only with insurance coverage policies but also across the entire health-care field.
“When it’s a family, I think the discrimination happens to everyone,” she said. “In that sense, [same-sex] couples are at-risk and so are their children.”
On Aug. 1, same-sex couples celebrated their ability to legally marry in Minnesota and the Minnesota Department of Commerce released a bulletin to insurers providing guidance on covering same-sex couples and their dependents.
In the bulletin, Commerce Commissioner Mike Rothman said that insurance companies should not discriminate against consumers based on their sexual preference or marital status. Rothman also that “companies may still choose whether its policies provide dependent benefits” but “companies cannot define ‘spouse’ in a way that would limit coverage to opposite-sex spouses.”
With the onset of the Affordable Care Act looming, Monahan said she believes that issues of health-care insurance access for children should disappear.
“In 2014, any problems that did exist with not being able to access coverage will go away because then, anyone can purchase coverage from the [health insurance] exchange,” she said.
Monahan said that because Obamacare’s insurance exchanges will allow everyone — particularly individuals and small businesses — to obtain coverage at competitive and affordable rates, same-sex couples won’t be as dependent on their employers for insurance.
“The rules for that market will change so that anyone who applies for coverage will be able to access coverage.”
Kathryn G. Nelson is a freelance journalist from the Twin Cities.