Affordable Care Act Improves Insured Rate of Individuals in the Justice System

Individuals involved with the criminal justice system were more likely to receive mental health or substance use disorder treatment.

New findings suggest that the Affordable Care Act may have played a role in increasing health insurance coverage among individuals in the justice system.

This population was more likely to receive treatment for mental illness, alcohol and substance use disorders, according to a study published by the Journal of General Internal Medicine.

Researchers also found that Medicaid beneficiaries were also more likely to receive treatment for depression or illicit drug use during the first few years after the Affordable Care Act was implemented.

However, health coverage for this population was still less than the general population.

In the study, researchers analyzed data from the National Survey of Drug Use and Health, and included 16,000 adults younger than 65-years-old who were on probation, parole, or had been arrested between 2008 and 2014. Also included in the study were 218,000 adults who had no involvement with the justice system. Findings were based on data from after the implementation of the Affordable Care Act and associated mandates.

“The mandate that insurers cover young adults on their parents' plans had a larger effect on justice-involved individuals than on other adults under age 26,” said lead author of the new study Tyler Winkelman, MD, MSc. “We were surprised by the magnitude of the effect -- a 13 percentage point drop -- which suggests that private health insurance reform can be an important tool to increase coverage in this group.”

Researchers said that their findings demonstrate the success of the Affordable Care Act mandate that allows young adults to stay on the parents’ health insurance plans until 26-years-old. This is especially important because substance use disorders and onset of mental illness are common among individuals in their late teens and early 20s.

Previous research indicates that up to 70% of justice-involved individuals have a substance use disorder or a mental illness. While the uninsured rate of this population decreased over time, the uninsured rate of individuals without justice system involvement decreased more rapidly in 2014.

“Similarly, Medicaid expansion and the new private insurance exchanges significantly reduced uninsurance for this population," adds Winkelman, a Robert Wood Johnson Clinical Scholar at IHPI. "But their uninsurance rates remain substantially higher than the general population. More work is needed to close the insurance gaps, and to ensure that that insurance coverage leads to better rates of treatment for substance use, mental illness, and chronic disease."

Despite gains in coverage, their findings also showed that privately insured individuals involved in the justice system were less likely to receive treatment for illicit drug use or depression compared with Medicaid beneficiaries. Researchers speculated that this could be linked to Medicaid’s care-coordination services and robust infrastructure for treatment.

Additional efforts by the justice system to enroll individuals in health insurance during jail and prison stays have been adopted by some states, but others do not enroll them prior to release. Enrolling all individuals prior to release may decrease the uninsured rate in this population.

The researchers said that more information is needed to examine the issue further, the study concluded.