Full Citation

Title: Increasing Health Insurance Coverage for Same-Sex Couples: The Roles of the ACA and Same-Sex Marriage

Citation Type: Miscellaneous

Publication Year: 2019

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Abstract: This paper examines the roles of the Affordable Care Act (ACA) and employer spousal coverage made possible by same-sex marriage in increasing health insurance coverage for same-sex couples in the United States. I use data from the American Community Survey in a difference-in-differences model on same-sex couples in ACA Medicaid expansion states to determine if people who did not have access to legal same-sex marriage at the time of the ACA had larger gains in insurance coverage postACA than those who already had access to marriage. I find a 1.8pp larger increase in Medicaid coverage and a 3.5pp larger increase in overall coverage for states that had not passed same-sex marriage before the main ACA implementation. These differences are the combined effects of the initial differential response to the ACA and the subsequent direct response to same-sex marriage passage in the post period. When I directly control for same-sex marriage passage, I find a 2.8pp larger increase in Medicaid and suggestive evidence for increased crowd-out of employer coverage in states without access to same-sex marriage at the time of the public insurance expansion.

Url: http://acsweb.ucsd.edu/~cswete/pdfs/Swete_JMP.pdf

User Submitted?: No

Authors: Swete, Chelsea

Publisher: University of California, San Diego

Data Collections: IPUMS USA

Topics: Family and Marriage, Other, Population Health and Health Systems

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