HRC Blog

Marriage Equality for Public Health in Indiana

Guest contribution provided by Jonathan Warus, Human Rights Campaign member and 4th year medical student attending the Indiana University School of Medicine.


Marriage equality in the United States has been changing rapidly with 6 states and the District of Columbia currently allowing same-sex marriage.  Washington will be added to the list in June 2012, Maryland in January 2013, and California pending further appeals.  Although many great strides have been made in the past few years, there are still many states with constitutional bans on same-sex marriage and others in the process of creating new bans.  Here in Indiana, same-sex marriage is currently banned by law, but not by the state constitution.  This could very well be changing in the next couple of years.  Legislators in Indiana have already passed HJR-6 once in 2011, calling for a state constitutional amendment limiting marriage to one man and one woman.  This resolution must pass a second time in 2013 and will then be placed on the election ballot for public referendum in November 2014.  Given the conservative nature of Indiana, it could prove difficult to prevent HJR-6 from writing discrimination into our state constitution.

In March 2012, the Indiana University School of Medicine offered its first ever Concepts in Human Sexuality for the Clinician elective to fourth-year medical students.  As a group of 15 soon-to-be doctors, we were given the challenge of creating a group project related to health and sexuality in Indiana.  We decided to team up with Dr. William C. Buffie, a physician working at St. Francis Hospital in Indianapolis.  Dr. Buffie published a research article in the American Journal of Public Health in 2011 that outlines the health-related evidence behind the marriage equality debate1.  He has worked with the Indiana State Medical Association in trying to push for public recognition of the health issues and for statements of support for marriage equality from the organization. 

In reviewing the research, I have quickly realized the vast number of articles relating marriage equality to better health outcomes.  The LGBT population as a whole suffers from higher rates of depression, anxiety, suicidal ideation, and suicide attempts compared to the heterosexual population.  These increases can be explained by a discussion regarding the concept of minority stress.  This model attributes the increased psychological problems in the LGBT population to the everyday stress, discrimination, and stigma created by society for existing outside the cultural norm.  As opposed to minority stress associated with other discrimination (such as race), sexual orientation is often invisible to others.  This leads to a more subtle form of discrimination.  For example, asking an unknowingly gay coworker if he has a girlfriend implies what is seen as normal for that individual.

For me personally, one of the most thought-provoking studies by Hatzenbuehler, et al2 surveyed 34,653 LGB individuals before and after 14 states approved constitutional amendments banning same-sex marriage.  For those individuals who lived in states without a constitutional ban, there was no change seen in the amount of psychiatric diagnoses.  However, for those individuals who lived in states with a constitutional ban on same-sex marriage, there were significant increases in the number of mood disorders, generalized anxiety disorder, alcohol disorder, and having more than one psychiatric diagnosis after the ban was passed.  This study is a great example of the social stigma and discrimination that is reinforced when laws restrict marriage equality.

Access to health insurance can often be difficult for LGBT individuals.  Many employers do not offer benefits for same-sex partners.  Even if benefits are available for same-sex dependents, they are considered taxable income by the federal and some state governments.  This results in a higher cost for the same insurance for LGBT individuals.  Due to these difficulties in acquiring private insurance, more LGBT persons are forced to pursue public insurance, moving the cost to the public domain. 

On the bright side of the issue, The Health and Marriage Equality in Massachusetts survey3 was administered by the Massachusetts Department of Public Health in 2009, 5 years after marriage equality was passed in the state.  LGBT individuals felt more accepted by their families and communities as a result of marriage equality and felt more committed to their partner.  Of particular concern for medical professionals, 83% of the survey participants stated that they were more likely to reveal their sexual orientation to their healthcare providers as a result of marriage equality.  This is a very important aspect of providing adequate healthcare to all individuals.  Without a strong doctor-patient relationship, optimal healthcare is difficult, if not impossible.

In addition to the self-reported benefits of marriage, the cost of mental healthcare decreased in a Massachusetts study by Hatzenbuehler et al4.  The study was conducted at a community-based health center 12 months before and after same-sex marriage became legal.  The average total mental health costs for an LGBT individual at this center decreased by 14% after marriage equality began.

The American Medical Association has taken a strong position in preserving LGBT rights.  They supported the repeal of “Don’t Ask, Don’t Tell” and have released statements expressing their support of the rights of same-sex couples.  As a future healthcare provider in Indiana, I will spend my life working for the best health outcomes for all of my patients.  After reviewing all of the research behind the health aspects of marriage equality, it is clear that allowing HJR-6 to pass will lead to further health disparities in Indiana.  The goal of our group is to educate the public on the literature that is out there and to encourage the medical community to take the lead on ensuring the best healthcare possible for patients.  We have already received a large outpouring of support from the community and will continue to spread awareness and understanding of the public health impacts of marriage equality.


For more information on Marriage Equality for Public Health, please visit our Facebook group and sign our online petition.



1: Buffie WC. Public Health Implications of Same-Sex Marriage. Am J Public Health. 2011;101(6):986-990.

2: Hatzenbuehler ML, McLaughlin K, Keyes K, Hasin D. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. Am J Public Health. 2010;100(3):452-459.

3: Ramos C, Goldberg NG, Badgett MV. The effects of marriage equality in Massachusetts: a survey of the experiences and impact of marrage on same-sex couples. Available at http://williamsinstitute Accessed April 15, 2012.

4: Hatzenbuehler ML, O’Cleirigh C, Grasso C, Mayer K, Safren S, Bradford J. Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: a quasi-natural experiment. Am J Public Health. 2012;102(2):285-291.