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October 6, 1999

Domestic Partnership Benefits at Medical Universities

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Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999American Medical AssociationThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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JAMA. 1999;282(13):1289-1292. doi:10.1001/jama.282.13.1289-JMS1006-4-1

At present, an employee's benefits package can represent as much as 30% to 40% of value added to a base salary.1 So-called soft benefits, such as bereavement leave, facilities use, and employee assistance programs, cost little to provide. "Hard benefits," on the other hand, are usually of considerable value; these include medical, dental, vision, and mental health coverage, prescription drugs, tuition grants, and accidental death and dismemberment and dependent life insurance.

Over the last half-century workers have received medical insurance as an employment benefit because employers were able to negotiate volume-discounted costs for expensive policies and programs. Benefits have historically been nontaxable and limited to the employee, a legal spouse, and dependent children.

Gay men and lesbians cannot obtain a civil marriage license or access employee spousal benefits. As a result, the couple must purchase a separate individual, usually more expensive insurance policy for the nonemployed partner and the partner's biological children.

Fighting for Benefit Equity

In December 1988, colleagues at Albert Einstein College of Medicine informed me that their spouses received medical insurance as an employment benefit. Upon inquiry at the benefits office, I was informed that state laws did not require coverage of my life partner, so we would not be offered medical insurance. My department chair suggested asking the faculty senate to mandate coverage.

On September 13, 1989, my resolution was presented, citing Yeshiva University's "long-standing commitment to equal opportunity . . . without regard to race, religion, creed, color, natural origin, sex, age, handicap, veteran or disabled veteran status, marital status, or sexual orientation."2 The resolution noted that not all people could obtain marriage licenses entitling them to certain privileges of employment. The resolution asked that the senate mandate "insurance benefits, education benefits, and housing accommodations without regard to sexual orientation for all faculty and students who share domicile and mutual responsibility for each other's welfare and basic living expenses, and who have either a marriage license or mutual power of attorney."2 It passed unanimously.

Coverage was not forthcoming, however, because the health plan "treat[ed] all unmarried individuals equally and cannot differentiate between groups of unmarried individuals who may happen to cohabitate" (K. Prince, Manager of Employee Benefits of Albert Einstein College of Medicine, written communication, November 22, 1989). Upon consultation, the American Civil Liberties Union's lawyers drafted a letter citing New York City's nondiscrimination policy inclusive of sexual orientation and a state court verdict recognizing domestic partnership in rental disputes (J.D. Marks, written communication to C. Margolin, Associate General Counsel to Montefiore Medical Center, December 13, 1989).3 Legal counsel drew up a confidential settlement contract for me in early 1990. In March 1991, after other staff and faculty sought similar contracts, Montefiore Medical Center became the largest private employer to provide domestic partner health coverage, announcing it was "the fair thing to do."4

Debating the Merits

When I began employment at Stanford University, I and my life partner again purchased separate medical insurance. This time, I joined other staff and faculty to establish an equal benefit policy. Three hard benefits and 4 soft benefits tied to legal marriage status formed the basis of the Benefit Parity Bill.5 Over 240 supportive faculty members signed an open letter to the faculty senate, and the undergraduate student union and the medical school faculty senate both passed the bill.

In May 1991, the senate discussion included comments comparing domestic partner insurance coverage with tuition grant reimbursement for children one did not have,6 neither being a deserved benefit. Another worry was that gay men and lesbians would flock disproportionately to Stanford seeking greater benefits.6 The bill was sent for subcommittee review, which recommended passing the bill and reported the following:

"One imagines, for example, that a decision by Stanford 40 years ago to take the lead in eradicating discrimination against blacks, women, or Jews in admissions, hiring, memberships in sororities and fraternities, etc, would have been politically unpopular with many alumni, as well as with the larger political community. One also imagines that had Stanford taken such a leadership role, few in the Stanford community would look back on that decision now with anything but pride."7

Over a year after introduction, the bill passed in September 1992. Stanford's trustees voted to implement it the following February.8

Why Domestic Partner Benefits?

Currently, 141 colleges and universities, 87 cities and counties, and 570 companies provide domestic partner benefits. Utilization rates run from 0.5% to 2.5%, making the costs of equal treatment minimal.1 Often employees request benefit parity, and employers respond to stay competitive.

Gay and lesbian employees have familial responsibilities like other people and are more productive when secure and financially stable. Medical institutions are more attractive to all potential employees if benefits packages are equally-accessible. If a medical center or university bars discrimination due to marital status, equal access to employment benefits is a reasonable corollary. The American Psychological Association, American Psychiatric Association, American Medical Association, and American Medical Women's Association endorse equal treatment for all regardless of sexual orientation.912

Kohn  S The Domestic Partner Organizing Manual.  Washington, DC National Gay and Lesbian Task Force1999;120- 128
O'Hanlan  KA Resolution passed September 13, 1989. Presented at: Faculty Senate of Yeshiva University September 13, 1989 Bronx, NY
Not Available, Braschi v Stahl, 74 NY2d 201, 543 NE2d 49, 544 NYS2d 784 (1989).
Not Available, Statement on benefits for domestic partners [press release].  Bronx, NY Office of Public Relations of Montefiore Medical Center March26 1991;
O'Hanlan  KA Benefit Parity Bill. Presented at: Faculty Senate of Stanford University October19 1991; Palo Alto, Calif.
Bush  CN Senate postpones consideration of bill extending benefits to domestic partners. Stanford University Campus Report. May22 1991;1- 13
Fried  B Report of the Subcommittee on Domestic Partners' Benefits.  Palo Alto, Calif University Committee for Faculty and Staff Benefits of Leland Stanford Jr University June1992;37- 38
Benefits Office of Stanford University, Important special edition: special open enrollment for same-sex domestic partners. Total Compensation News. December1992;1- 6
Bersoff  DNOgden  DW APA amicus curiae briefs: furthering lesbian and gay male civil rights. Am J Psychol. 1991;46950- 956Article
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Third Edition.  Washington, DC American Psychiatric Association1994;538
Council on Scientific Affairs, American Medical Association, Health care needs of gay men and lesbians in the United States. JAMA. 1996;2751354- 1359Article
American Medical Women's Association, Position paper on lesbian health. J Am Med Womens Assoc. 1993;4986