David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Ramakrishnan); Department of Health Policy, Vanderbilt University School of Medicine, Nashville (Fry).
Psychiatr Serv. 2024 Jan 1;75(1):76-80. doi: 10.1176/appi.ps.20220260. Epub 2023 Aug 2.
This study examined whether expansions of Affordable Care Act (ACA) coverage led to changes in insurance coverage and behavioral health treatment use among adults with past-year criminal legal interactions.
National Survey on Drug Use and Health data and a difference-in-differences design were used to compare changes in insurance coverage and behavioral health treatment use among respondents with a mental or substance use disorder, by past-year criminal legal involvement (N=103,818).
Prior to ACA expansions, respondents with past-year criminal legal involvement (vs. without) were less likely to have insurance (61.5% vs. 79.3%) or to receive mental health treatment (34.7% vs. 36.3%). The ACA coverage expansions reduced insurance disparities for people with criminal legal involvement by almost 5 percentage points. No changes in behavioral health treatment use were found.
Future policies that help people with criminal legal involvement get connected to coverage and treatment are warranted to address persistent disparities in coverage and treatment receipt.
本研究旨在探讨《平价医疗法案》（ACA）覆盖范围的扩大是否导致过去有刑事法律互动的成年人的保险覆盖范围和行为健康治疗使用发生变化。
利用国家药物使用与健康调查数据和双重差分设计，比较了过去一年有刑事法律参与（N=103818）的受访者中，有精神或物质使用障碍者的保险覆盖范围和行为健康治疗使用的变化情况。
在 ACA 扩大之前，过去一年有刑事法律参与的受访者（与没有刑事法律参与的受访者相比）获得保险的可能性较小（61.5%比 79.3%），获得心理健康治疗的可能性也较小（34.7%比 36.3%）。ACA 的覆盖范围扩大使有刑事法律参与的人的保险差距缩小了近 5 个百分点。但在行为健康治疗的使用方面没有发现变化。
未来需要制定政策，帮助有刑事法律参与的人获得覆盖和治疗，以解决在覆盖和治疗接受方面持续存在的差距。
