By James René Jolin, ; Benjamin A. Barsky, ; Carrie G. Wade; et alMeredith B. Rosenthal, PhD3,5

 IMPORTANCE - By expanding health insurance to millions of people in the US, the Patient Protection and Affordable Care Act (ACA) may have important health, economic, and social welfare implications for people with criminal legal involvement—a population with disproportionately high morbidity and mortality rates. OBJECTIVE To scope the literature for studies assessing the association of any provision of the ACA with 5 types of outcomes, including insurance coverage rates, access to care, health outcomes, costs of care, and social welfare outcomes among people with criminal legal involvement. EVIDENCE REVIEW - The literature search included results from PubMed, CINAHL Complete, APA Psycinfo, Embase, Social Science Database, and Web of Science and was conducted to include articles from January 1, 2014, through December 31, 2023. Only original empirical studies were included, but there were no restrictions on study design. FINDINGS Of the 3538 studies initially identified for potential inclusion, the final sample included 19 studies. These 19 studies differed substantially in their definition of criminal legal involvement and units of analysis. The studies also varied with respect to study design, but difference-in-differences methods were used in 10 of the included studies. With respect to outcomes, 100 unique outcomes were identified across the 19 studies, with at least 1 in all 5 outcome categories determined prior to the literature search. Health insurance coverage and access to care were the most frequently studied outcomes. Results for the other 3 outcome categories were mixed, potentially due to heterogeneous definitions of populations, interventions, and outcomes and to limitations in the availability of individual-level datasets that link incarceration data with health-related data. CONCLUSIONS AND RELEVANCE-  In this scoping review, the ACA was associated with an increase in insurance coverage and a decrease in recidivism rates among people with criminal legal involvement. Future research and data collection are needed to understand more fully health and nonhealth outcomes among people with criminal legal involvement related to the ACA and other health insurance policies—as well as the mechanisms underlying these relationships.  

JAMA Health Forum. 2024;5(8):e242640. doi:10.1001/jamahealthforum.2024.2640

By Emily Lupton Lupez,  Steffie Woolhandler, ; David U. Himmelstein

Growing old and dying inside: improving the experiences of older people serving long prison sentences Dr Jayne Price In partnership with the Building Futures Programme. This report is an uncomfortable read, shining a stark light on the difficulties faced by the increasing number of older people serving long sentences. For me, four issues stand out from the consultation that underpins this report. First, the experiences of the men and women who took part powerfully illustrate the mismatch between the diverse needs of this often-hidden group of people and the rigidity of many prison regimes. These needs cannot be met by the prison system alone but raise important challenges for health and social care commissioners and providers, as well as external partners involved in the provision of purposeful activities. Second, that this activity is critical for many older people serving long sentences. But many find that few opportunities are available to them. For the ageing population future employment is less of a concern, how their time, often decades, can be spent productively and meaningfully in activities suited to their age and length of sentence. The testimonies here suggest that governors should enhance the role that prisoners themselves can play in supporting others. This report suggests that when encouraged effectively, those serving long sentences can help to fill the gaps that currently exist in many parts of the estate. Third, like much of PRT’s Building Futures Programme, this report demonstrates the value of enabling people with lived experience to engage in issues of operational and policy improvement and provides ideas for positive change. It also includes very personal, honest, and desperate reflections about the experience of incarceration. This underlines what we see at Recoop: many older people inside feel they are punished not just through losing their liberty but also through a series of humiliations and deprivations throughout their sentence, which can get harder as they age. Finally, those who participated in this report provide a painful reminder of the need for a national strategy for older prisoners; something promised by the government in 2020 but yet to be published. The pressure on the Ministry of Justice (MoJ) to provide decent, safe, and rehabilitative secure environments is probably as acute as it has ever been, particularly with the current and very real overcrowding challenges. This cannot be achieved without a comprehensive, integrated and estate-wide approach. The long-awaited older prisoner strategy must address the changes required, including ensuring funding and commissioning is in alignment. This requires joint working and commitment from the MoJ, Public Health and NHS England to fulfil their collective responsibilities to address the perfect storm of issues that is painfully illustrated in this report. Without this, it will not be able to deliver what is needed. 

London: Prison Reform Trust, 2024. 52p.