The Affordable Care Act and Changes in Insurance Coverage and Source of Health Care Among High-risk Rural, Substance-using, Female Offenders Transitioning to the Community

J Health Care Poor Underserved. 2018;29(3):843-863. doi: 10.1353/hpu.2018.0064.


Purpose: This study examines health care coverage and health care among rural, drug-involved female offenders under the Affordable Care Act (ACA) compared with pre-ACA and whether being insured is associated with having a usual source of care.

Methods: This study involved random selection, screening, and face-to-face interviews with drug-using women in three rural Appalachian jails. Analyses focused on participants who had completed a three-month follow-up interview after release from jail (N=371).

Results: Analyses indicated that women released after ACA implementation were more likely than those released pre-implementation to be insured. A multivariate logistic regression model showed that being insured was significantly related to having a usual health care source during community re-entry.

Conclusions: Results demonstrate the benefits of the ACA, signaling important implications for public health in rural communities and the criminal justice system, including targeting underserved groups during incarceration and providing information about and resources for health care enrollment.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Appalachian Region
  • Community Integration
  • Criminals / psychology*
  • Criminals / statistics & numerical data
  • Delivery of Health Care / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health / statistics & numerical data*
  • Patient Protection and Affordable Care Act*
  • Prisons
  • Risk Assessment
  • Rural Population* / statistics & numerical data
  • Substance-Related Disorders / epidemiology*
  • United States