Health Insurance Coverage and Access to Care by Sexual Orientation and Marital/Cohabitation Status: New Evidence from the 2015–2018 National Health Interview Survey

Abstract

Disparities in health insurance coverage and access to care are well documented between sexual minority adults and their heterosexual peers. Much less research has examined whether marital status affects access to care by sexual orientation identity. This study used data on nonelderly gay/lesbian adults (n = 1740), bisexual adults (n = 1138), and their heterosexual counterparts (n = 80,329) from the 2015–2018 National Health Interview Survey. Multivariable logistic regression models estimated the differences in health insurance status and access to care between married and cohabiting adults to single adults by sexual orientation. Compared to single adults, married adults were more likely to have private health insurance and less likely to have public health insurance regardless of sexual orientation. Married heterosexual and gay/lesbian adults were more likely to have a usual source of care and less likely to experience delayed or unmet medical care and mental health care due to cost compared to their single counterparts. We found fewer statistically significant differences between married and single bisexual adults and between married and cohabiting adults of all sexual orientations. Our study demonstrates that married gay, lesbian, and bisexual adults are more likely to have private health insurance and fewer financial barriers to care compared to their single counterparts. Given the recent recognition of legal same-sex marriage for sexual minorities, much more research is needed to document if and how marriage affects access to care and health outcomes by sexual orientation.