Employment and Health Among Recently Incarcerated Men Before and After the Affordable Care Act (2009-2017)

Objectives. To explore whether and how the Affordable Care Act (ACA) affects the relationship between employment and health insurance coverage, health care utilization, and health outcomes among recently incarcerated men aged 18 to 64 years in the United States.Methods. With data from the National Survey on Drug Use and Health (NSDUH), we used a difference-in-differences approach to compare changes in outcomes by employment status among recently incarcerated men.Results. Uninsurance declined significantly among recently incarcerated men after ACA implementation. As the uninsured rate of unemployed men fell below that of their employed counterparts, the ACA helped to fully eliminate the effect of employment on insurance coverage among recently incarcerated men. The employment gap in diabetes widened after ACA implementation as unemployed men saw significant increases in diagnosed diabetes. Employment disparities in hospital visits, diagnosed hypertension, and reported mental illness also declined in the period following ACA implementation, but these changes were not statistically significant.Conclusions. These findings highlight how the ACA, by providing a new route to health care, reduces the confounding forces associated with employment that are linked to both incarceration and health.