Access to Employer-Sponsored Health Coverage for Same-Sex Spouses: 2018 Update
Using the latest data from our annual Employer Health Benefits Survey (EHBS), we assessed access to employer sponsored health insurance (ESI) coverage for same sex spouses in 2018, as well as trends over time; ESI remains the primary way people in the U.S. receive health coverage, either directly or as a spouse or other dependent.1 We found that while access to same sex-spousal coverage through ESI is increasing, it remains significantly less common than the offer of opposite sex spousal coverage. In 2018, nearly two-thirds (63%) of employers offering health insurance to opposite sex spouses also offered coverage to same sex spouses and the share of employees with such access has increased over time so most (88%) now have access. These increases follow two Supreme Court rulings (United States v Windsor and Obergerfell v Hodges) which changed the legal landscape for same-sex couples, ultimately guaranteeing the right to marriage nationwide and paving the way for wider access to health insurance through the workplace.2 Still, neither court decision requires private employers to offer this benefit and tracking access through ESI remains important.
In 2018, nearly two-thirds (63%) of firms offering health insurance coverage to opposite-sex spouses also provided coverage to same-sex spouses, a significant increase from 43% in 2016 (see Figure 1).3 The share of firms reporting that they do not provide such coverage (6% in 2018) also declined significantly from 2016 (when it was 16%). Just under a third (31%) of firms reported they had not encountered this as a benefits issue, a finding driven by small employers (those with fewer than 200 workers), who represent the majority of employers overall (98%).4
The likelihood of employers offering both opposite sex spousal coverage and same-sex spousal coverage increases with firm size (see Figure 2). Large firms (those with 200 or more employees) were more likely to offer coverage to same-sex spouses compared to smaller firms (87% vs 62%). Almost nine in ten (87%) large firms with opposite-sex spousal coverage offered such coverage, 9% did not, and 4% reported they had not encountered this benefits issue. Among the largest firms (those with more than 1,000 workers), 93% offered coverage to same-sex couples. By contrast, just 62% of small employers (3-199 workers) offered coverage to same-sex spouses. Six (6%) percent did not and 32% said they had not encountered it.
While the majority of firms in the United States are small, the majority of covered workers are employed by large firms (200 or more workers) (see Figure 3).5 In 2018, among employees who worked at firms offering opposite-sex spousal health benefits, 88% also had access to same-sex spousal coverage, up significantly from 84% in 2016 and 2017 (see Figure 4). Six percent (6%) did not have access to this benefit, and 6% worked at firms who reported they had not encountered this benefits issue.
As with firms offering, the share of employees with access to same-sex spousal coverage increases with firm size (see Figure 5). Most covered workers (95%) at large firms (those with 200 or more employees) who have access to opposite-sex spousal coverage also have access to same-sex spousal coverage. Just 5% did not, and 1% worked at firms that reported they had not encountered the issue. Among workers at the largest firms (1,000+ workers), nearly all (97%) had access to same-sex spousal coverage.
Workers at small firms offering opposite-sex spousal coverage were less likely to have access to health insurance benefits for same-sex spouses, though a majority did (72%). Nine percent (9%) did not have access to this benefit and another 19% worked at firms that report they have not encountered this issue.
Domestic Partner Benefits
Prior to the Supreme Court decisions guaranteeing the right to marriage for same-sex couples, domestic partnership benefits provided an important way for same-sex couples to gain access to coverage. Some have raised questions about whether federal and state recognition of same-sex marriage would diminish domestic-partnership benefits but, as was the case in 2016 and 2017, we found no statistical difference between the share of large firms offering same-sex domestic partner health coverage in 2018 compared to 2012, among large firms offering health benefits.6 Further, almost all (96%) large firms offering same-sex domestic partner health benefits also offer same-sex spousal benefits; 66% of large firms offering same-sex spousal coverage offer same-sex domestic partner coverage. Additional data on domestic partner benefits can be found in the full EHBS survey.7
These findings indicate that access to employer coverage for same-sex spouses is increasing in the U.S., though it still is significantly less than access to opposite sex spousal coverage.. Coverage varies significantly by employer size, with employees at small firms being less likely to have access to same-sex spousal coverage and the largest employers almost uniformly offering this benefit. In some cases, lack of access to this benefit could be a policy decision though that appears to be declining, with smaller shares of firms saying they do not provide same sex spousal coverage Going forward, it will be important to monitor access to same-sex spousal coverage in the workplace over time and against changes in the legal landscape.
The annual survey was conducted between January and July of 2018 and included 2,160 randomly selected, non-federal public and private firms with three or more employees. In 2018, the response rate among firms which offer health benefits was 32%. For fuller methods see The Kaiser Family Foundation 2018 Annual Employer Health Benefits Survey available at: www.kff.org/ehbs.