Abstract
The 2014 National Research Council report on American incarceration optimistically anticipated the Affordable Care Act (ACA) would be “a turning point in the nation's health care, and … will provide unprecedented access to care for many people being released from correctional facilities.” However, the ACA was not designed to proactively respond to risks associated with prisoner re-entry into society. Our overarching hypothesis is that unmet health needs among previously incarcerated adults can be more fully understood by analyzing how un-prescribed use of drugs, such as opioids, is associated with economic and health problems and health care un-insurance that in turn results in exclusion from needed health care services. Using several waves of the National Longitudinal Study of Adolescent to Adult Health conducted before and after passage and implementation of ACA, our analysis indicates that the above risk factors nearly fully mediate the association between previous incarceration and failure to receive needed health care. We argue that these factors are likely intensified by a reactive approach to health care reform that not only fails to cover many former prisoners, but also is lacking in sufficient outreach programming, and as such is insufficient for adults with health problems and limited economic resources - especially those using un-prescribed opioids. Future work should address the capacity of more proactively organized public health programs to expand coverage to previously incarcerated populations - including un-prescribed opioid users - and thereby reduce their health risks and vulnerability to repeated exposure to law enforcement surveillance and criminal punishment.
| Original language | English (US) |
|---|---|
| Article number | 105897 |
| Journal | Preventive medicine |
| Volume | 130 |
| DOIs | |
| State | Published - Jan 2020 |
Funding
We appreciate the support of grant #SES-1535563 from the National Science Foundation for this research. We also thank the anonymous reviewers and editors for their helpful comments. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website (http://www.cpc.unc.edu/addhealth). No direct support was received from grant P01-HD31921 for this analysis. We appreciate the support of grant # SES-1535563 from the National Science Foundation for this research. We also thank the anonymous reviewers and editors for their helpful comments. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website ( http://www.cpc.unc.edu/addhealth ). No direct support was received from grant P01-HD31921 for this analysis.
Keywords
- Affordable Care Act
- Health care access
- Health care policy
- Incarceration
- Opioids
ASJC Scopus subject areas
- Epidemiology
- Public Health, Environmental and Occupational Health
