The Defense of Marriage Act, which requires the federal government to recognize only marriages between one man and one woman, is indefensible is so many ways.  However, the consequent lack of health insurance among gay couple dependents—and the resulting diminished access to affordable mental health care and inevitable increased number of suicides—makes DOMA unconscionable.

It’s no secret (as demonstrated in numerous studies in the U.S. and abroad) that gay men and lesbians suffer from higher rates of mental disorders, substance abuse, and suicide attempts than their heterosexual counterparts.  Given these numbers, it seems clear that gay people would benefit even more than the general population from access to affordable mental health care.  Unfortunately, gay people are almost twice as likely as their heterosexual counterparts to lack health insurance (22% vs. 10%).  There are multiple reasons for this disparity, but a 2010 study of same-sex couples in California suggests that one significant reason for this disparity is the difficulty same-sex couples have in securing employee-based health insurance for the dependent partner.

Here’s an example:  If my partner is employed by a company in Georgia, where same-sex marriage is not permitted, there’s no guarantee that the company he works for will provide health insurance for same-sex dependents (as opposed to legally married dependents who would automatically be covered).  Even if my partner’s company extended health insurance benefits to same-sex partners, my partner would have to pay state and federal taxes on that benefit because we’re not recognized by either the state of Georgia or the federal government as a married couple.  That extra cost can easily be the barrier that makes health insurance unaffordable.  (If you’re a legally married couple, those dependent health benefits are not taxed.)

Because of DOMA, getting married in a state where same-sex marriage is permitted in order to secure dependent health benefits in a state where it’s not is no solution.  For example, even if my partner and I were married in New York—where same-sex marriage became legal yesterday—Georgia is permitted by law to ignore a legal marriage license from another state if the marrying partners are of the same sex.

Without health insurance, people with mental disorders inevitably delay seeking treatment or get no treatment at all.  And people who don’t receive treatment are at a greater risk of suicide.  So it’s a simple formula:  No insurance = no treatment for mental disorders = more suicides.  DOMA repeal = more people insured = treatment for mental disorders = fewer suicides.  Marriage equality is not about weddings.  It’s a matter of life and death.

•  The content and sources (see below) for this blog post are drawn from:  Haas, A.P. et al.  (2011).  Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations:  review and recommendations.  Journal of Homosexuality.  58(1):10-51.

  1. Harris Interactive News Room, Nearly one in four gay and lesbian adults lack health insurance. May 19, 2008. Accessed at:
  2. Ponce, N. A., Cochran, S. D., Pizer, J. C., & Mays, V. M. (2010). The effects of unequal access to health insurance for same-sex couples in California. Health Affairs, 29(8), 1539–1548.
  3. 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.
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  5. Cochran, S. D., Mays, V. M., Alegria, M., Ortega, A. N., & Takeuchi, D. (2007). Mental health and substance use disorders in Latino and Asian-American lesbian, gay and bisexual adults. Journal of Consulting and Clinical Psychology, 75(5), 785–794.
  6. 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.
  7. Gilman, S. E., Cochran, S. D., Mays, V. M., Hughes, M., Ostrow, D., & Kessler, R. C. (2001). Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. American Journal of Public Health, 91(6), 933–939.
  8. McCabe, S. E., Hughes, T. L., Bostwick, W. B., West, B. T., & Boyd, C. J. (2009).  Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction, 104(8), 1333–1345.
  9. King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., et al. (2008, August 18). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and bisexual people. BMC Psychiatry, 8: 70. Retrieved June 8, 2009, from
  10. McLaughlin, C. G. (2004). Delays in treatment for mental disorders and health insurance coverage. Health Services Research, 39(2), 221–224.
  11. Wang, P. S., Berglund, P. A., Olfson, M., & Kessler, R. C. (2004). Delays in initial treatment contact after first onset of a mental disorder. Health Services Research39(2), 393–415.



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