Disparities in Health Insurance Coverage and Access to Care for Children By Mother’s Sexual Orientation

Abstract

Objective

Few population-based studies have examined the health care experiences of children with sexual minority parents. The purpose of this study was to compare health insurance status, access to care, and health services utilization for children by mother’s sexual orientation.

Methods

We used data on children with lesbian mothers (n = 195), bisexual mothers (n = 299), and heterosexual mothers (n = 23,772) in the 2013–2017 National Health Interview Survey. Logistic regression models were used to compare health insurance status, access to care, and health services utilization while adjusting for demographic and socioeconomic characteristics of the child, mother, and household.

Results

After controlling for sociodemographic factors, there were no statistically significant differences in health insurance coverage, access to care, or health services utilization between children of lesbian mothers and children of heterosexual mothers. Compared to children with heterosexual mothers, children with bisexual mothers were more likely to have public health insurance (OR 2.33; 95% CI 1.07–7.68), delayed medical care due to cost (OR 2.33; 95% CI 1.12–4.86), unmet medical care due to cost (OR 2.86; 95% CI 1.07–7.68), and a visit to the emergency room (OR 1.74; 95% CI 1.27–2.39) in the prior year after controlling for child-level characteristics. Some of these differences were attenuated after controlling for maternal demographics and household characteristics.

Conclusions for Practice

Children with bisexual mothers experience barriers to routine medical care. Addressing socioeconomic dimensions of health care access and targeted outreach to bisexual parents will help promote health equity for children growing up in sexual minority households.

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References

  1. Aksoy, C. G., Carpenter, C. S., & Frank, J. (2018). Sexual orientation and earnings: new evidence from the United Kingdom. ILR Review,71(1), 242–272.

    Google Scholar 

  2. American Academy of Child and Adolescent Psychiatry. (2009a). Gay, lesbian, bisexual, or transgender parents. Retrieved January 31, 2019, from https://www.aacap.org/aacap/policy_statements/2008/Gay_Lesbian_Bisexual_or_Transgender_Parents.aspx

  3. American Academy of Child and Adolescent Psychiatry. (2009b). Sexual orientation, gender identity, and civil rights. Retrieved January 31, 2019, from https://www.aacap.org/aacap/policy_statements/2009/Sexual_Orientation_Gender_Identity_and_Civil_Rights.aspx

  4. American Academy of Child and Adolescent Psychiatry. (2018). Conversion therapy. Retrieved from December 16, 2019, from https://www.aacap.org/aacap/policy_statements/2018/Conversion_Therapy.aspx

  5. Anderssen, N., Amlie, C., & Ytteroy, E. A. (2002). Outcomes for children with lesbian or gay parents: A review of studies from 1978 to 2000. Scandinavian Journal of Psychology,43, 335–351.

    PubMed  Google Scholar 

  6. Austin, S., Ziyadeh, N., Fisher, L., Kahn, J., Colditz, G., & Frazier, A. (2004). Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Archives of Pediatrics and Adolescent Medicine,158(4), 317–322.

    PubMed  Google Scholar 

  7. Baker, K. E., McGovern, A., Gruberg, S., & Cray, A. (2016). The Medicaid Program and LGBT Communities: Overview and Policy Recommendations. Washington, DC: The Center for American Progress.

    Google Scholar 

  8. Blewett, L. A., Drew, J. A. R., Griffin, R., King, M. L., & Williams, K. C. W. (2016). IPUMS Health Surveys: National Health Interview Survey, Version 6.2. Minneapolis.

  9. Blosnich, J. R., Farmer, G. W., Lee, J. G. L., Silenzio, V. M. B., & Bowen, D. J. (2014). Health inequalities among sexual minority adults. American Journal of Preventive Medicine,46(4), 337–349.

    PubMed  PubMed Central  Google Scholar 

  10. Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010). Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. American Journal of Public Health,100(3), 468–475.

    PubMed  PubMed Central  Google Scholar 

  11. Cahill, S. R., Baker, K., Deutsch, M. B., Keatley, J., & Makadon, H. J. (2016). Inclusion of sexual orientation and gender identity in stage 3 meaningful use guidelines: A huge step forward for LGBT health. LGBT Health,3(2), 100–102.

    PubMed  Google Scholar 

  12. Cahill, S., & Makadon, H. (2014). Sexual orientation and gender identity data collection in clinical settings and in electronic health records: A key to ending LGBT health disparities. LGBT Health,1(1), 34–41.

    PubMed  Google Scholar 

  13. Calzo, J. P., Mays, V. M., Bjorkenstam, C., Bjorkenstam, E., Kosidou, K., & Cochran, S. D. (2019). Parental sexual orientation and children’s psychological well-being: 2013–2015 National Health Interview Survey. Child Development,90(4), 1097–1108.

    PubMed  Google Scholar 

  14. Carpenter, C. S. (2005). Self-reported sexual orientation and earnings: evidence from California. Industrial and Labor Relations Review,58(2), 258–273.

    Google Scholar 

  15. Carpenter, C., & Gates, G. J. (2008). Gay and lesbian partnership: evidence from California. Demography,45(3), 573–590.

    PubMed  PubMed Central  Google Scholar 

  16. Claxton, G., Rae, M., Long, M., & Damico, A. (2017). Employer Health Benefits: 2017 Annual Survey. San Francisco, CA: Kaiser Family Foundation.

    Google Scholar 

  17. Committee on Psychosocial Aspects of Child and Family Health. (2002). Coparent or second-parent adoption by same-sex parents. Pediatrics,109(5), 339–340.

    Google Scholar 

  18. Committee on Psychosocial Aspects of Child and Family Health. (2013). Promoting the well-being of children whose parents are gay or lesbian. Pediatrics,131(4), 827–830.

    Google Scholar 

  19. Conron, K. J., Mimiaga, M. J., & Landers, S. J. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health,100(10), 1953–1960.

    PubMed  PubMed Central  Google Scholar 

  20. Fredriksen-Goldsen, K. I., Kim, H.-J., Shui, C., & Bryan, A. E. B. (2017). Chronic health conditions and key health indicators among lesbian, gay, and bisexual older adults, 2013–2014. Amerian Journal of Public Health,107(8), 1332–1338.

    Google Scholar 

  21. Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H.-J., Lehavot, K., Walters, K. L., Yang, J., et al. (2014). The health equity promotion model: reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry,84(6), 653–663.

    PubMed  Google Scholar 

  22. Gates, G. J. (2013). LGBT Parenting in the United States. Los Angeles, CA: The Williams Institute.

    Google Scholar 

  23. Gates, G. J. (2014). In U.S., LGBT more likely than non-LGBT to be uninsured. Retrieved March 3, 2016, from https://www.gallup.com/poll/175445/lgbt-likely-non-lgbt-uninsured.aspx

  24. Gonzales, G. (2014). Same-sex marriage—a prescription for better health. New England Journal of Medicine,370(15), 1373–1376.

    CAS  PubMed  Google Scholar 

  25. Gonzales, G., & Blewett, L. A. (2013). Disparities in health insurance among children with same-sex parents. Pediatrics,132(4), 703–711.

    PubMed  Google Scholar 

  26. Gonzales, G., Przedworski, J., & Henning-Smith, C. (2016). Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: Results from the National Health Interview Survey. JAMA Internal Medicine,176(9), 1344–1351.

    PubMed  Google Scholar 

  27. Grasso, C., McDowell, M. J., Goldhammer, H., & Keuroghlian, A. S. (2019). Planning and implementing sexual orientation and gender identity data collection in electronic health records. Journal of the American Medical Informatics Association,26(1), 66–70.

    PubMed  Google Scholar 

  28. Hatzenbuehler, M. L., McLaughlin, K. A., Keyes, K. M., & Hasin, D. S. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study. American Journal of Public Health,100(3), 452–459.

    PubMed  PubMed Central  Google Scholar 

  29. Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academies Press.

    Google Scholar 

  30. Kim, H. J., & Fredriksen-Goldsen, K. I. (2012). Hispanic lesbians and bisexual women at heightened risk or health disparities. American Journal of Public Health,102(1), 9–16.

    Google Scholar 

  31. Manning, W. D., Fettro, M. N., & Lamidi, E. (2014). Child well-being in same-sex parent families: Review of research prepared for American Sociological Association Amicus Brief. Population Research and Policy Review,33(4), 485–502.

    PubMed  PubMed Central  Google Scholar 

  32. Mays, V. M., Yancey, A. K., Cochran, S. D., Weber, M., & Fielding, J. E. (2002). Heterogeneity of health disparities among African American, Hispanic, and Asian American women: Unrecognized influences of sexual orientation. American Journal of Public Health,92(4), 632–639.

    PubMed  PubMed Central  Google Scholar 

  33. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin,129(5), 674–697.

    PubMed  PubMed Central  Google Scholar 

  34. Mize, T. D. (2016). Sexual orientation in the labor market. American Sociological Review,81(6), 1132–1160.

    Google Scholar 

  35. Mulé, N. J., Ross, L. E., Deeprose, B., Jackson, B. E., Daley, A., Travers, A., et al. (2009). Promoting LGBT health and wellbeing through inclusive policy development. International Journal for Equity in Health,8, 1–11.

    Google Scholar 

  36. National Center for Health Statistics. (2014). A Brief Quality Assessment of the NHIS Sexual Orientation Data. Atlanta: National Center for Health Statistics.

    Google Scholar 

  37. National Center for Health Statistics. (2017). Health, United States, 2016: With Chartbook on Long-Term Trends in Health. Hyattsville: National Center for Health Statistics.

    Google Scholar 

  38. Patterson, C. J. (1992). Children of lesbian and gay parents. Child Development,63(5), 1025–1042.

    CAS  PubMed  Google Scholar 

  39. Patterson, C. J. (2006). Children of lesbian and gay parents. Current Directions in Psychological Science,15(5), 241–244.

    Google Scholar 

  40. Perrin, E. C., & Committee on Psychosocial Aspects of Child and Family Health. (2002). Technical report: coparent or second-parent adoption by same-sex parents. Pediatrics,109(2), 341–344.

    PubMed  Google Scholar 

  41. Perrin, E. C., Siegel, B. S., & Committee on Psychosocial Aspects of Child and Family Health. (2013). Promoting the Well-Being of Children Whose Parents Are Gay or Lesbian. Pediatrics,131(4), e1374–e1383.

    PubMed  Google Scholar 

  42. Potter, D. (2012). Same-sex parent families and children’s academic achievement. Journal of Marriage and Family,74(3), 556–571.

    Google Scholar 

  43. Reczek, C., Spiker, R., Liu, H., & Crosnoe, R. (2016). Family structure and child health: does the sex composition of parents matter? Demography,53, 1605–1630.

    PubMed  PubMed Central  Google Scholar 

  44. Romero, A. P., Baumle, A., Badgett, M. V. L., Gates, G. (2007). Census snapshot: United States. Los Angeles, CA: The Williams Institute. Retrieved December 16, 2019, from https://escholarship.org/uc/item/6nx232r4

  45. Ross, L. E., Salway, T., Tarasoff, L. A., MacKay, J. M., Hawkins, B. W., & Fehr, C. P. (2018). Prevalence of depression and anxiety among bisexual people compared to gay, lesbian, and heterosexual individuals: a systematic review and meta-analysis. Journal of Sex Research,55(4–5), 435–456.

    PubMed  Google Scholar 

  46. Warbelow, S., & Diaz, B. (2017). 2017 State Equality Index. Washington, DC: Human Rights Campaign.

    Google Scholar 

  47. Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. (2014). Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013. National Health Statistics Reports,2(77), 1–12.

    Google Scholar 

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Correspondence to Gilbert Gonzales.

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Gonzales, G., McKay, T. & Carpenter, C.S. Disparities in Health Insurance Coverage and Access to Care for Children By Mother’s Sexual Orientation. Matern Child Health J 24, 630–639 (2020). https://doi.org/10.1007/s10995-019-02857-7

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Keywords

  • LGBT health
  • Access to care
  • Health disparities