Association for Public Policy Analysis & Management

In 2013, the U.S. Supreme Court struck down major provisions of the federal Defense of Marriage Act (DOMA) defining marriage between one man and one woman in U.S. v Windsor, which required the federal government to recognize state-level same-sex marriages. By the end of 2014, 35 states allowed same-sex couples to marry within their jurisdictions. This study takes advantage of the “natural experiments” that occurred in states legalizing same-sex marriages following the repeal of DOMA to examine the impact of same-sex marriage laws on employer-sponsored health insurance (ESI) coverage and employment outcomes for adults in same-sex relationships. Using data from the 2010-2014 American Community Survey on adults in same-sex (n=30,375) and different-sex (n=285,072) relationships, this study used a difference-in-differences approach to test whether same-sex marriage laws differentially affected ESI coverage and employment for adults in same-sex relationships in states recognizing same-sex marriage compared to states not enacting same-sex marriage laws. All models controlled for age, education, income, citizenship, homeownership and the presence of a child in the household. After controlling for demographic and socioeconomic characteristics, repealing DOMA led to an adjusted 4-6 percentage point increase (p<0.05) in ESI coverage for women in same-sex relationships; a similar effect was not found for men in same-sex relationships.  Increases in ESI coverage were strongest for whites, adults with college degrees, and adults in a same-sex relationships where one member was employed by the federal government. Meanwhile, compared to women in different-sex relationships, women in same-sex relationships experienced small declines in full-time employment, but these reductions were not significant at traditional levels (p>0.10). This study provides early evidence that repealing the federal same-sex marriage ban was associated with increased employer health benefits for members of cohabiting same-sex couples without negative labor supply effects. Gender-specific differences in our results also suggest that lesbian couples may potentially gain more economic and health benefits than male gay couples following the adoption of federal marriage equality, which began after the US Supreme Court struck down the remaining state-level same-sex marriage bans in Obergefell v Hodges.