More Employers Offer Employer-Sponsored Same-Sex Spousal Coverage

December 02, 2020 - Same-sex couples are increasingly gaining access to employer-sponsored same-sex spousal coverage, but benefits remain less accessible than for heterosexual couples, a recent Kaiser Family Foundation (KFF) issue brief found.

“We find that, as of mid-2020, while employer offer of same-sex spousal coverage has increased over time, it remains less common than opposite sex spousal coverage,” the brief stated. 

“These increases follow two other Supreme Court rulings (United States v Windsor and Obergerfell v Hodges) which guaranteed the right to marriage nationwide and paved the way for wider access to health insurance through the workplace.”

In addition to these Supreme Court cases, the brief highlighted another case from 2020, Bostock vs. Clayton County, which determined that it is illegal for an employer with 15 employees or more to use sexual orientation or gender identity as the basis for firing a worker.

The researchers used data from the 2020 KFF Employer Health Benefits Survey to evaluate employer-sponsored health plan access among same-sex couples.

More than seven in ten employers that offered heterosexual spousal coverage also offered same-sex spousal coverage (74 percent). This is a 31 percent increase from four years ago, when 43 percent provided same-sex spousal coverage.

Outside of that share of employers, 21 percent of employers responded that they had not had to make a decision on this issue. This could mean that no employees had asked for the benefit or that there was no company policy on it.

In 2016, 41 percent of employers said that they had not encountered this issue, demonstrating that this share of the employer population is shrinking as more employees request the benefit or as companies formulate policies on the subject.

The remaining five percent stated that they do not offer the benefit, nearly matching the 2018 response.

Firm size is a major factor in whether or not employers offer both heterosexual and same-sex spousal coverage.

Nearly nine in ten large companies—with 200 workers or more—that provided heterosexual spousal coverage also offered same-sex spousal coverage and 95 percent of the largest firms—with 1,000 workers or more—offered both benefits.

Two percent of large employers said that they had never encountered the issue and nine percent did not offer same-sex spousal coverage.

In comparison, less than three-quarters of the smallest companies—with three to 49 workers—that provided heterosexual spousal coverage also offered same-sex spousal coverage. Nearly a quarter of the smallest companies said they had never encountered the issue (23 percent) while four percent did not offer the benefit.

Recognizing the impact of firm size is critical to understanding access to same-sex spousal coverage because, while more small companies exist in America than large companies, most Americans are employed by a large company.

Thus, a higher percentage of large companies offering same-sex spousal coverage necessitates that a high percentage of the American workforce have access to these benefits.

Accordingly, in 2020, 91 percent of employees who worked at companies that covered heterosexual couples also had access to same-sex spousal coverage. This percentage has steadily inched upward since 2016.

A small fraction of the workforce did not have access to the benefit (five percent) and a similar amount worked at companies that stated they had not encountered the issue (four percent).

Employees who were least likely to have access to same-sex spousal coverage were those who worked at companies with 50 to 199 employees. Fifteen percent of those who worked in these companies did not have access to same-sex spousal coverage.

The KFF researchers indicated that the Bostock vs Clayton County decision could have both an expanding and a narrowing effect for this coverage option.

While more companies may be required to offer same-sex spousal benefits due to sex protections, five percent of employees work at companies that are exempt from this rule and other employers may choose not to offer the benefits under religious liberty exemptions.

While the coronavirus pandemic has shifted conversational priorities in healthcare to some degree, sexual discrimination in healthcare access and coverage has continued to receive some attention in the past year.

Earlier in 2020, payers reacted to the finalized HHS nondiscrimination rule which eliminated gender and sexual discrimination language, along with other more specific language.

The Department of Health and Human Services defended the move saying that many relevant definitions were already set forth under the civil rights statutes.

Researchers have also discovered discrimination against HIV patients in the South, where prior authorization requirements prevented speedy treatment for patients with HIV.