Abstract
Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA). We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative sample of prisoners to estimate the number eligible for healthcare coverage at release. There were 643,290 US male prisoners aged 18–64 with a chronic health condition. At release, 73% in Medicaid-expansion states would qualify for Medicaid or tax credits. In non-expansion states, 54% would qualify for tax credits, but 22% (n = 69,827) had incomes of ≤ 100% the federal poverty limit and thus would be ineligible for ACA-mediated healthcare coverage. These prisoners comprise 11% of all male prisoners with a chronic condition. The ACA was projected to provide coverage to most male state prisoners with a chronic health condition; however, roughly 70,000 fall in the “coverage gap” and may require non-routine care at emergency departments. Mechanisms are needed to secure coverage for this at risk group and address barriers to routine utilization of health services.
Highlights
Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population.[1,2,3] The most recent national survey of prisoners (2011–2012) suggests that 50% of state and federal prisoners have a chronic medical condition.[1]
Our study population was composed of male state prisoners aged 18–64 years who reported a history of at least one of the 18 chronic health conditions assessed in the survey: hypertension, diabetes, heart disease, stroke, asthma, kidney disease, arthritis, hepatitis, cirrhosis, cancer, human immunodeficiency virus (HIV), paralysis, depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, a psychotic disorder, or a personality disorder
In line with the earlier analysis by Cuellar and Cheema, we examined the effect of a 15% “wage penalty,” on our results, which we applied to our “low,”“mid-point” and “high” analyses resulting in six estimates of the number of male state prisoners who would be within the coverage gap at release
Summary
Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population.[1,2,3] The most recent national survey of prisoners (2011–2012) suggests that 50% of state and federal prisoners have a chronic medical condition.[1] Though limited, existing research suggests that prior to 2014, most released prisoners did not have health insurance in the 8–10 months after release. [4] Reasons for this lack of insurance have not been well documented, but are likely related to lack of employment (and employment-based insurance), limited perceived need among those who PLOS ONE | DOI:10.1371/journal.pone.0160085. Released Prisoners' Healthcare Coverage role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Though limited, existing research suggests that prior to 2014, most released prisoners did not have health insurance in the 8–10 months after release. [4] Reasons for this lack of insurance have not been well documented, but are likely related to lack of employment (and employment-based insurance), limited perceived need among those who PLOS ONE | DOI:10.1371/journal.pone.0160085 August 1, 2016
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