Association for Public Policy Analysis & Management

Background: Previous studies have documented disparities in health insurance coverage and access to medical care for sexual minorities in the United States. However, health insurance expansions under the Affordable Care Act and recent legal changes (e.g. same-sex marriage laws) affecting sexual minorities may have narrowed differences in health care access.

Objective: The purpose of this study was to compare changes in health insurance status and access to care for nonelderly sexual minorities and their heterosexual peers between 2013 and 2016.

Methods: Data on 1,481 sexual minorities and 47,624 heterosexuals aged 18-64 years were obtained from the 2013 and 2016 National Health Interview Survey. Unadjusted and adjusted prevalence estimates compared changes in health insurance status and health care access for sexual minorities and heterosexuals, with analyses stratified by gender.

Results: Uninsurance declined for both sexual minority and heterosexual adults between 2013 and 2016. Reductions in uninsurance for sexual minorities were associated with increases in dependent employer-sponsored insurance (ESI) coverage and public health insurance. Sexual minority men reported declines in unmet medical care needs due to cost. Sexual minority women reported reductions in delayed care due to cost and unmet dental, pharmaceutical, and mental health care needs due to cost.

Conclusions: Sexual minorities are more likely to have health insurance coverage in recent years, but gaps in health care access remain. These changes were likely to due to simultaneous changes in health insurance coverage under the Affordable Care Act and same-sex marriage policy.