Implementation of the ACA: Releasing Former Prisoners from a High Risk of Death
Summary
Former prisoners face an elevated risk of death upon their release from confinement, especially from causes amenable to health care, including drug overdose, untreated chronic health conditions, and suicide. Despite their significant burden of poor health, formerly incarcerated individuals have historically gone without needed medical care outside of prisons, in part due to their overwhelming lack of health insurance. Implementation of the Patient Protection and Affordable Care Act (ACA) significantly increased health insurance coverage among formerly incarcerated individuals. Whether and how the risk of death following release from prison has changed accordingly, however, remains unknown. Leveraging variation across states in the implementation of the ACA, this project will explore whether and how changes in the provision of health insurance affect the risk of death among individuals recently released from prison. By investigating changes in the risk of death among formerly incarcerated individuals before and after ACA implementation across Medicaid expansion and non-expansion states, this project will provide evidence on how government policy interventions can address the relationship between incarceration and mortality, and will raise important questions about how state-level contexts shape the risk of deaths amenable to health care. In light of how incarceration is deeply concentrated among Black and Latino men, results from this project will also have profound implications for our understanding of how health insurance status, incarceration, and state policy environments combine to shape population disparities in health across race/ethnicity and gender.