Effects of Access to Legal Same-Sex Marriage on Marriage, Health, and Substance Use: Evidence from BRFSS

We exploit variation in access to legal same-sex marriage (SSM) across states and time to provide novel evidence of its effects on marriage and health using data from the CDC BRFSS from 2000-2016, a period spanning the entire rollout of legal SSM across the United States. Our main approach is to relate changes in outcomes for individuals in same-sex households (SSH) [i.e., households with exactly two same-sex adults], which we show includes a substantial share of gay and lesbian couples, coincident with adoption of legal SSM in two-way fixed effects models. We find robust evidence that access to legal SSM significantly increased marriage take-up among men and women in SSH. We also find that legal SSM was associated with significant increases the likelihood of being insured, having a usual health care provider, and having a past year checkup for men in SSH. We do not find consistent effects on alcohol use, heavy episodic drinking, or smoking, nor do we find effects on the number of days of bad physical or mental health. Our results provide the first direct evidence that legal access to SSM was associated with significant improvements in healthcare access for adult gay men.