Expert Commentary

State marriage laws and the health of same-sex couples

2015 study published in the American Journal of Public Health on the relationship between state marriage laws and the health of same-sex couples.

On June 26, 2015, the U.S. Supreme Court issued an opinion in the case of Obergefell v. Hodges, saying that same-sex couples have the Constitutional right to marry. Previously, state laws varied in terms of the rights and protections offered to gays and lesbians. Hawaii was the first state to offer domestic-partnership benefits to same-sex couples in 1997. Seven years later, Massachusetts became the first to recognize same-sex marriage. By the 2015 ruling, these unions already were legal in the vast majority of states and the District of Columbia. The ruling effectively required the 13 states that prohibited same-sex couples from getting marriage licenses to reverse their policies.

It is difficult to know how many same-sex couples there are in the United States, and estimates differ. In late 2014 the U.S. Census Bureau estimated there were 251,695 “same-sex married couple households” based on an analysis of data from the 2013 American Community Survey (ACS). However, subsequent research by the Census Bureau indicates that the true number may be about 170,429. A 2015 analysis from the Williams Institute, a think tank at the UCLA Law School, suggests that there are approximately 690,000 same-sex couples, both married and unmarried.

Previous research about gay and lesbian couples has focused on issues such as parenting, family finances and employer-sponsored medical insurance. A 2015 study published in the American Journal of Public Health, “State-Level Marriage Equality and the Health of Same-Sex Couples,” looks at the connection between state marriage laws and the health of individuals in same-sex relationships. The researchers — Ben Lennox Kail, Katie L. Acosta and Eric R. Wright of Georgia State University — analyzed survey data collected between 2010 and 2013 as part of the U.S. Census. One item asked participants to rate their health on a scale from one to five, a measure that other research has found to be a strong indicator of future illness and death. The study then compared the health ratings of same-sex couples based on whether their states, during those years, recognized same-sex marriage or civil unions or had anti-gay marriage constitutional amendments.

The study’s findings include:

  • Same-sex couples living in states with legally sanctioned marriage had higher levels of self-assessed health compared to those living in states with anti-gay marriage constitutional amendments. People living in a state with legally sanctioned marriage were 1.71 times more likely to be in better health.
  • There was no difference in self-reported health among couples in states with no legal recognition of same-sex partnerships versus states with civil unions only.
  • The relationship between marriage laws and self-reported health did not appear to differ for lesbian couples versus gay couples.

The authors note a number of limitations in the study, and potential confounding effects: Because the study did not compare the health of same-sex couples to opposite-sex couples, the authors were not able to establish a causal relationship between marriage equality and health improvements. In addition, because many states’ same-sex marriage laws are relatively recent, they might not have impacts for several more years. Finally, states with laws that fall short of full equality might not improve the health of same-sex couples any better than in states with anti-gay marriage amendments.

“The variation of health in same-sex couples observed across different states might … be a function of varying levels and degrees of institutional discrimination across states,” the authors state. “In this regard, our analysis suggested that a federal-level response establishing full-marriage equality for same-sex couples across the country could serve as an important public health intervention to improve the health status of and reduce the health disparities among same-sex couples, regardless of state of residence.”

Related research: A 2014 study published in the Journal of Policy Analysis and Management,  “Revisiting the Income Tax Effects of Legalizing Same-Sex Marriages,” looks at the federal and state tax implications of legalizing same-sex marriage.


Keywords: gay couples, gay marriage, civil rights, LGBT, LGBTQ

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