Health Care beyond the Gates: The ACA's Effects on Health-Related Outcomes of Previously Incarcerated Men

• In Event: 4411 - Challenges and Barriers in Health Care Delivery

Abstract

Adults involved in the criminal justice system have historically had very little access to health care outside of jail and prison. Since the mid-20th century, U.S. healthcare policies have required working-age adults to access health insurance through labor market, marriage, and family institutions. As the pathways expected to provide access to coverage are themselves highly stratified, the risk of being uninsured has been particularly high for men with histories of incarceration. In this study, I leverage the timing of the ACA’s implementation as a “natural experiment” to explore the relationship between incarceration and health. With data from the National Survey on Drug Use and Health (NSDUH), I use a difference-in-differences approach to compare measures of health insurance, health care, and health status among low-income men from before and after key provisions of the ACA became active in 2014. All men of lower income are patterned by social determinants linked to low levels of health insurance, health care, and health status, but there are important reasons to expect that the ACA would have unique consequences for those involved in the criminal justice system. Emphasizing the U.S. criminal justice system as not only an important axis of stratification but also an institutional determinant of health, I compare whether and how the ACA differentially affects these outcomes for men with and without histories of incarceration. Results from this study show that the ACA helped provide significant and substantive improvements on levels of health insurance coverage, health care use, and health status measures among men with a history of incarceration. These findings add to our understanding of the association between incarceration and health, and raises important questions about the centrality of institutional determinants for our knowledge of health inequalities.

Author

• Carmen Marie Gutierrez, University of North Carolina at Chapel Hill