Keywords: sexual minority men and women, health disparities, access to care
While insurance coverage has increased during ACA implementation and marriage equality expansion, sexual minority adults experience substantial health disparities relative to heterosexual peers. Moreover, the conclusions of some studies may be sensitive to analytic decisions about small groups. Multivariate analyses of 2014-2015 NHIS data compared 7 barriers to care among 67,023 heterosexual and 2,080 sexual minority adults. Within sex strata we compared all sexual minority adults to heterosexual peers and sexual minority subgroups (e.g., lesbian/gay, bisexual adults) to heterosexual adults and each other, evaluating statistical power issues in several common approaches in the literature. Some barriers were 2x as likely among sexual minorities than for heterosexual peers, and 1.5x as likely when controlling for health and sociodemographics. There were few statistically-significant adjusted differences between gay/lesbian and bisexual adults, given small subgroup sample sizes. This finding contrasts with some previous studies that focused on differences in statistical significance when comparing 2 small sexual minority groups to heterosexual counterparts.