This week marks the seventh anniversary of Obergefell v. Hodges, the landmark Supreme Court case that declared marriage as a constitutional right for LGBTQ+ couples. This historic decision followed another U.S. Supreme Court case, U.S. v. Windsor, which decided that the federal government must recognize same-sex marriages. In the most recently available data, the U.S. Census Bureau estimates that approximately 60 percent of the 980,000 same-sex households in the United States are married. But why is marriage equality important for LGBTQ+ couples and what does the evidence show?
A large body of evidence has demonstrated that heterosexual marriage leads to longer, happier, and healthier lives for straight couples. Married couples often monitor each other’s health behaviors, provide each other social and emotional supports, schedule health care visits, and frequently enroll in the same health plan. Prior to marriage equality, these benefits were frequently unavailable to LGBTQ+ couples. Many employers did not cover same-sex spouses, and same-sex couples feared discrimination and being denied access to their spouse in hospitals and funeral homes.
Now that we are seven years beyond the nationwide recognition of marriage equality, what has the research shown? Several studies have shown that when individual states legalized marriage equality, health insurance coverage increased and mental health improved for same-sex couples and LGBTQ+ populations. In a study conducted at the Vanderbilt LGBTQ+ Policy Lab, we used large-scale data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) and found that marriage equality across all 50 states and the District of Columbia led to improvements in health insurance coverage and access to care for same-sex couples. Of course, previous research has been limited by data issues, but more national and state-level data sources are collecting sexual orientation and gender identity which has fueled the growth of LGBTQ+ health services research.
Indeed, many Americans decide to postpone or forgo marriage. According to the Pew Research Center, 38 percent of adults between 25-54 years old are living without a spouse or partner and 9 percent are cohabiting with an unmarried partner. Both estimates are the highest recorded in recent decades. Given that fewer adults are getting married, it may be time to rethink our social safety net — which often prioritizes married families with children. Some employers are already responding to the evolution of families and households in the 21st century. The Kaiser Family Foundation’s Employer Health Benefits Survey found that at least a third of all employers offer health benefits to unmarried and cohabiting domestic partners — whether they are straight or LGBTQ partners.
While marriage equality has been one important step towards LGBTQ+ equality, we are still far from LGBTQ+ health equity. LGBTQ+ health disparities are persistent and may be widening, especially for our transgender and gender diverse peers who are facing new state-level policies and actions that prevent them from accessing health care, sports and recreational activities, restrooms, and other public accommodations because of their gender identity. I encourage all health services researchers to continue collecting data on sexual orientation and gender identity in every way possible so that we can monitor the impacts of all policies on LGBTQ+ health.
On a more personal note, this year my spouse and I celebrate our five-year wedding anniversary. We were only able to get married in Tennessee as a direct result of Obergefell v. Hodges. Unfortunately, the future of marriage equality remains in limbo. On June 24, 2022, the U.S. Supreme Court overturned Roe v. Wade and will allow states to prohibit access to abortions. In his concurring opinion, Justice Clarence Thomas said that the Supreme Court should also reconsider Obergefell v. Hodges (in addition to cases on contraception and same-sex sexual relationships). Overturning Obergefell v. Hodges will undoubtedly limit access to marriage, worsen health outcomes, and create barriers to care for LGBTQ+ populations. In order to promote LGBTQ+ health equity, more legal protections are needed to secure marriage equality and to prohibit discrimination throughout the social determinants of health.