Has Marriage Equality for LGBTQ People Impacted Access to Domestic Partner Health Benefits?

Prior to marriage equality, LGBTQ people had limited access to dependent health benefits compared to opposite-sex couples as there were no requirements that they be offered in the workplace. Some employers aimed to mediate this disparity, in part, by offering unmarried couples domestic partner health insurance benefits. Questions have since been raised about whether these benefits would remain following marriage equality and civil rights decisions. In this data note, based on KFF’s 2023 Employer Health Benefit Survey, we assess the current status of domestic partner health insurance benefit offerings for same-sex spouses against this backdrop.

Access to employer-sponsored health insurance for same-sex couples was fundamentally transformed by the Supreme Court rulings on same-sex marriage (United States v. Windsor, in 2013, which permitted states to perform same-sex marriages and Obergefell v. Hodges, in 2015, which made same-sex marriage legal nationwide). Marriage equality brought with it new access to certain benefits for LGBTQ people, including dependent health insurance. In addition, a more recent Supreme Court case, Bostock v. Clayton County (2020), held that federal civil rights law prohibiting sex discrimination in employment includes protections based on sexual orientation or gender identity.1 Together, these decisions mean that access to same-sex spousal employment benefits are likely required when they are also offered to opposite-sex couples by moderate-sized employers.2

In the early 2000’s, prior to the state and federal marriage decisions, about one-third of large firms offered domestic partner health insurance benefits to same-sex couples. The share of large firms offering same-sex domestic partner health benefits increased from 34% in 2011 to 42% in 2012, the year prior to the Windsor decision, potentially reflecting greater attention to the rights of LGBTQ people as marriage equality was being debated nationwide.

Since that time, there have been no significant year-to-year changes in the share of firms offering same-sex couples domestic partner health benefits, with 45% of firms offering in 2023. In other words, following the Supreme Court decisions securing protections for LGBTQ people, the share of firms offering same-sex domestic partner health benefits has not declined, as might have been expected.

It is likely that firms continue to make this coverage available because it provides employees with a benefit irrespective of marital status, and may allow employers that historically offered domestic partner benefits to continue to make a statement about equity. In addition, some states, such as California, require certain employers to offer such coverage. Further, because almost all (96%) employers require some employee contributions toward dependent coverage, employers do not absorb the full cost of providing this benefit, which may increase their willingness to offer access. For employees, the retention of domestic partner health insurance coverage benefits while also offering coverage to same-sex spouses provides broader options for coverage in households regardless of marital status.

  1. These protections, provided via Title VII of the Civil Rights Act, apply to employers with at least 15 workers.

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  2. In 2023, almost all (99%) large firms in the U.S report offering dependent health coverage.

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