Abstract: The Patient Protection and Affordable Care Act (ACA) offers an important opportunity to examine the size, composition, and geographic distribution of the U.S. criminal legal system population. In the United States, more than 2 million people are incarcerated and an additional 5 million people are under community supervision through probation or parole on any given day. System-involved individuals experience an elevated burden of chronic health conditions, such as psychiatric and substance use disorders. Approximately 70-80% of people in jail and prison and 30-50% of individuals on probation or parole meet the criteria for having either a mental health or substance use disorder, compared to 10% of adults in the general population. The provision of treatment has been shown to substantially improve health outcomes and reduce the risk of re-arrest and re-incarceration. Yet, system-involved individuals have historically gone without treatment in part due to their overwhelming lack of health insurance coverage. Recent implementation of the ACA, however, substantially increased health insurance coverage among adults involved with the criminal legal system. Leveraging variation across states in the implementation of the ACA, this project explores whether and how increases in coverage affect the size, composition, and geographic distribution of the U.S. criminal legal system population. Results from this project will be the first to provide a national picture of the relationship between the ACA and the demography of criminal legal system involvement across states. Exploring this relationship will help identify the mechanisms that influence both the risk of criminal legal system involvement and the specific relationship between criminal legal system involvement and health.

Bio: Dr. Carmen Gutierrez is as an Assistant Professor in the Department of Public Policy at the University of North Carolina at Chapel Hill. In her research, Dr. Gutierrez examines how structural and institutional racism cause health inequalities among people in the United States. She is particularly interested in the ways that population health disparities are shaped by the US criminal legal system and the US immigration system. Her work on these topics blends perspective from social demography, critical race theory, and feminist geography to investigate the role of US institutions and policies in shaping Black and Brown people's health in unique ways. Dr. Gutierrez's research has appeared in the American Sociological Review, the American Journal of Public Health, Crime & Delinquency, and Pediatrics. Her work has been supported by the National Science Foundation and the National Institutes of Health. Prior to joining the faculty at UNC, Dr. Gutierrez earned a B.A. in Sociology and Spanish from the University of Michigan in Ann Arbor and received her Ph.D. in Sociology from the University of Texas in Austin.