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Published Online: 2 August 2023

Equity Implications of the Affordable Care Act Among People With Past-Year Criminal Legal Interactions

Abstract

Objective:

This study examined whether expansions of Affordable Care Act (ACA) coverage led to changes in insurance coverage and behavioral health treatment use among adults with past-year criminal legal interactions.

Methods:

National Survey on Drug Use and Health data and a difference-in-differences design were used to compare changes in insurance coverage and behavioral health treatment use among respondents with a mental or substance use disorder, by past-year criminal legal involvement (N=103,818).

Results:

Prior to ACA expansions, respondents with past-year criminal legal involvement (vs. without) were less likely to have insurance (61.5% vs. 79.3%) or to receive mental health treatment (34.7% vs. 36.3%). The ACA coverage expansions reduced insurance disparities for people with criminal legal involvement by almost 5 percentage points. No changes in behavioral health treatment use were found.

Conclusions:

Future policies that help people with criminal legal involvement get connected to coverage and treatment are warranted to address persistent disparities in coverage and treatment receipt.

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File (appi.ps.20220260.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 76 - 80
PubMed: 37528700

History

Received: 15 May 2022
Revision received: 8 May 2023
Accepted: 9 June 2023
Published online: 2 August 2023
Published in print: January 01, 2024

Keywords

  1. Criminal legal system
  2. Health care reform
  3. Insurance
  4. Affordable Care Act

Authors

Affiliations

Abinaya Ramakrishnan, B.S.
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Ramakrishnan); Department of Health Policy, Vanderbilt University School of Medicine, Nashville (Fry).
Carrie E. Fry, Ph.D., M.Ed. [email protected]
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Ramakrishnan); Department of Health Policy, Vanderbilt University School of Medicine, Nashville (Fry).

Notes

Send correspondence to Dr. Fry ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

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