In Reply Dr Long is concerned about the measurement of same-sex couples in the ACS. Sexual orientation is not directly ascertained in the ACS. Same-sex couples are identified when the primary respondent identifies a cohabiting person in the household of the same sex as a husband, wife or unmarried partner, missing single LGB adults, same-sex couples not cohabiting together, and same-sex couples choosing not to disclose their relationship, which may bias the results. The findings should not be generalized to all LGB adults or same-sex couples.
Gonzales G. Marriage Equality Act and Changes to Health Insurance Coverage—Reply. JAMA. 2016;315(4):417-418. doi:10.1001/jama.2015.16458