DERAY MCKESSON: Hey this is DeRay. And welcome to Pod Save the People. In this episode, it’s me, Sam, Kaya, and De’Ara talking about the news that you don’t know, the news that might have gone underreported in this past week but that you should know. And then I sit down with Dr. Carmen Gutierrez, who talks about her research with regard to health care and incarceration. I learned so much from our conversation, but I wanted to share.

My advice for this week is go for a walk. I had a tough day today. Today was a long day. Today was a hard day. And I was like I’m actually going to record this intro while I’m on a walk.

And let me tell you, I made all the difference. Somebody delivered the wrong package to the buildings, I walked the package a block down, and it was like I just needed to go– today I was on my computer all day– I just needed to go for a walk and that walk changed everything. And the other thing I did when I hit a bump today is that I actually just I put on real clothes, I had on like Zoom clothes, but I was like, let me just put it off it. And that mattered a lot too. So that’s my advice for you this go round. Put on some clothes, take a walk.

DE’ARA BALENGER: Family, welcome to another episode of Pod Save the People. I am De’Ara Balenger. You can find me on Instagram and the Twitter @dearabalenger.

SAM SINYANGWE: And I’m Sam Sinyangwe, @samswey on Twitter.

DERAY MCKESSON: And this is DeRay. @deray on Twitter.

DE’ARA BALENGER: So news coming out of LA, I mean, Sam will give us more on this since he’s in the actual hotspot, but–

SAM SINYANGWE: I feel like the local meteorologist.

DERAY MCKESSON: The COVIDologist.

SAM SINYANGWE: We’re getting some hints of mask mandates in LA County that should be sustained for who knows how long. So get your masks, you’re going to need them again if you ain’t been wearing them, even if you’re vaccinated. So indoors at least. So that’s the new rule in LA County.

I don’t know, it seems like things are going in the wrong direction in terms of the numbers with regard to COVID in La County and across the country again. So buckle up, COVID Delta Force is coming again.

DERAY MCKESSON: One of the things that was interesting to me about the delta conversation was that it kept reading that it could lead to hyper local outbreaks. That like thankfully, more people are vaccinated, and it looks like we won’t have big, big shutdowns again, but like communities might close. So that’s interesting. And I’m sort of interested– and we should have somebody back in the pod to talk about the vaccine for kids, that that rollout has gone a little bit slower than I thought it would be.

And we think about the delta strain is apparently more contagious than the other strains and it’s just like you all get vaccinated. I was at an event the other day, and we had to go– it was a party afterwards, and you had to be vaccinated to go to the party. So I invite these people, I’m like, all you, Chicago is going be great to do that.

And they’re like, we’re not getting that thing. And I’m just like, why? And they’re like, because you don’t know what’s in it. I’m like, all the stuff I saw you just put in your body, you don’t know where that came from. So it is interesting to still see people be against it in ways, that like I don’t– there’s not like a rationale that I’ve understood. And I hope that we can get over this. And y’all have seen the stats. Almost all the people dying are unvaccinated. You’re like that’s not an ad for getting vaccinated. I don’t know what it is.

SAM SINYANGWE: It is wild. Like every month you see the stats like 99.2% of the people who die from COVID were unvaccinated. 99.3%, 99.4%. Like almost everybody. So that’s not a coincidence like that is the science, and the discrepancy between the science and like the politics and the behavior couldn’t be more stuck. So people are losing their lives over this. And you see COVID is evolving as well in ways that the vaccination itself.

Now they’re talking about authorizing a third sort of booster shot for Pfizer. So like the vaccines are now having to catch up with COVID which is evolving. And it’s evolving even more rapidly because fewer people are vaccinated and so it’s able to spread more quickly. So it’s all sort of tied together in a way that this is like the race isn’t over yet, like this is going to be a marathon. And clearly like get vaccinated if you aren’t already because you don’t want to be a part of that 99.2%. Like you want to be protected to a vast degree compared to not being vaccinated. And the science is like clear again and again and again on this.

DE’ARA BALENGER: Yeah. And I hope we continue to see more coming from this administration. There was this big push to have 70% of the population vaccinated by 4th of July. I know we didn’t hit that mark. And I feel like we didn’t hit that mark and it just was kind of a low. And we haven’t really heard any updates from there.

So– I don’t know– I would really like to see this administration think a little bit more creatively about how we get more people vaccinated. Madam VP and Barack Obama being recorded getting the shot isn’t helping anybody. I’d like to see the stats from Juvenile putting “Vax That Thang Up.” Vax–

DERAY MCKESSON: “Vax That Thang Up.” He did it. I was like this is the– this is the–

DE’ARA BALENGER: That saved countless lives.

SAM SINYANGWE: Countless lives were saved.

DERAY MCKESSON: That was a banger.

SAM SINYANGWE: Undoubtedly.

DE’ARA BALENGER: But I think that tactics like that are necessary. And so– I don’t know– we’ll continue to see. But as adults, a variant grows. yeah, like it’s going to be interesting to see what they do around these vaccination numbers.

So my news this week is an oped in The Washington Post by Karen Attiah, who I adore. This piece that she’s written really talks about the backlash against critical race theory particularly in Oklahoma. So we’ve talked about this on the pod time and time again, just the backlash against teaching truth in American public schools. I want you all to read the whole entire oped if you get a chance.

But just three points that really stood out to me in particular. The first one is Carlisha Williams Bradley, who is the only Black member of the Oklahoma school board. She is voting for critical race theory actually and was the single member of the Oklahoma school board to really push against not having just good old history. Actual truthful history. History that also encompasses what happened in 1921 with the massacre of Greenwood.

But anyhow, miss Bradley was the only member again, the only member of the board to vote no. She believes that Oklahoma’s new education law and its harsh punishment and some of the punishment is suspensions for teachers who decide to teach the truth, district defunding. And get this, the law states that this punishment is deserving for instruction that makes any individual feel discomfort, guilt, anguish or any other form of psychological distress on account of his or her race or sex. Clearly that justifies to his or her white race.

So that was one thing that really stood out. Number two is a young student a 16-year-old Black student named Sapphira Lloyd– and I hope I’m pronouncing her name correctly– who spoke after a handful of white women who spoke during this hearing. And among other things, the white women cried, of course, compared teaching critical race theory to the pretext of the Rwanda genocide. And another one said it was just downright bullying to teach history.

So Sapphira has said before the board, we should be able to discuss critical race topics no matter how ugly they may be and teach kids how to handle having hard conversations. She reminded everyone that 10% of American high school seniors could identify slavery as a central cause of the Civil War, only 10%, and that students are really taught that Thomas Jefferson believed that Black people were inferior to white people. Sapphira also went on to say that it seems that no one truly cares about my experience, everyone else’s experience matters except for my life.

The third thing that really impacted me deeply was what Karen put so eloquently and bluntly, essentially her way of summarizing the law. She says once the governor signs off on this law, Oklahoma will have the harshest penalties in the nation for the crime of making white people feel uncomfortable. So– I don’t know– I just wanted to bring this to the pod. I’m fortunate that my company, Maestra, does a ton of work in Oklahoma and we’re honored and proud to do it. But seeing news like this come out of this state is just tragic, disheartening.

So, yeah, shout out to Carlisha Williams Bradley, who was that lone vote. Just sending you vibes girl. So appreciate you.

SAM SINYANGWE: Reading this article, I was just reminded– I was recently in Greenwood during the centennial of the destruction of Black Wall Street, the massacre. And just being there and seeing how white supremacists essentially erased like this entire area, this entire community– and like by erased, it wasn’t like partially, it was like there were almost no structures left, almost nothing– they built a freeway over the area that used to be Greenwood, that used to be Black Wall Street, there was only a few structures standing, one of which was the Vernon AME Church.

And it wasn’t the whole church that was in it. It was like the basement that was preserved. Like the basement that was like one of the largest structures preserved. Everything else was burned, stolen, pillaged by white supremacists.

And now, fast forward 100 years almost to the date, 100 years and you have the state, you have legislators trying to finish that project, trying to continue that erasure. Right, part of the same project. Trying to make sure that people don’t learn the history, don’t learn about what many of those same legislators, grandparents, great grandparents might have been a part of, don’t learn about not only the destruction of Black Wall Street, not only that in Oklahoma but the history of Oklahoma is one of massacre after massacre, injustice after injustice against Black people, against Native Americans, against so many different communities and they’re trying to prevent students from learning about that. Discourage educators from teaching about it, discourage that knowledge from getting out.

And thank God for technology nowadays that at least make it possible for students to learn this information that, frankly has never been taught in schools in the first place. And so you’ve had to get this information from communities, from family members, from information online, from books, outside of school, in almost all cases. Because despite what these laws suggest, like students aren’t learning about this. That’s why only 10% of students in high school know that the Civil War was fought over Southerners wanting to preserve slavery.

So, again, like this is part of that same project and not only in Oklahoma. This is a wave of laws all across predominantly the South, predominantly the places that have had these massacres, have had these injustices, and are trying to cover them up. And so, again, like we have to push back against this and see this in the historical light that it’s in. This isn’t sort of an isolated incident. This isn’t just legislators suddenly feeling uncomfortable it’s part of a broader project of white supremacy that has taken lives and that has erased the damage that was done in the public understanding.

DERAY MCKESSON: I’m interested to see, like what is the consequence? Like teachers probably aren’t going to turn in on other teachers, and that might happen. But like I don’t actually see that being the thing. I think it’ll be parents who are the people like calling, being like you taught my child something about this. But I think about working in the school system in a school, like I don’t even at a point, if the teachers are just like we are not teaching on more, then what? Like then what do you do? Like I don’t even–

Or if all of a sudden, parents are organizing, especially because we’ve been home for a year and everybody starts homeschooling, then what? Then the school system shuts down like no revenue no kids, like I think that when people– like when this starts to get a little more real, because right now, school’s not in, and so this is like all just laws passing in the ether. Nobody is making decisions in classrooms right now because school’s out. I think that organized teachers and parents will show who’s boss when the fall comes. And I’m ready.

Like I can’t wait for like whole schools to be like, oh, cool we’re not coming back, just organize the school, the church or something. Like then what? And watch school systems just like fall apart. The second thing is that I hope that this leads to unbelievable shifts on school boards, because those are often positions that people are really paying attention to.

And I hope that like all of a sudden, no longer is she the lone vote, but they wipe all these people out, that we get them out of here. Like I hope that that is what happens when school comes back. Because teachers unions are pretty strong. They are. The right parents getting organized, I hope that they light these people up.

SAM SINYANGWE: So for my news, I want to talk about a new study that’s come out, that looks at this question of what role does electing a new district attorney, a new local prosecutor, have on reducing police violence? And to answer this question, two researchers, Allison Stashko at the University of Utah and Harriet Scarrow at Stanford University, took data from Mapping Police Violence looking at the time period from 2013 through 2017 of cases where people have been killed by the police across the country.

And compared it to data from a database of prosecutor elections, 2,315 different elections for local district attorneys during that time period. And what they find is that after a new district attorney is elected, there was a 17% reduction in killings by the police and that there was an even larger reduction in cases where there was a more contested and potentially high profile election. And so this is interesting for a number of reasons.

One, it’s interesting because most places don’t have contested DA elections. In most places you have district attorneys who have been there for a while, who run unopposed each time, and have these close relationships with the police whereby they never charged the police for killing people. And that’s not even like an exaggeration. We look at the data like year over year. In almost every county, no officers are charged with a crime for killing people.

What that means is that these district attorneys have close relationships with the police. The police know that they will not be charged, that they will not be held accountable for killing people. And when a new DA is elected, there might be more uncertainty and hesitation on the part of the police to use deadly force. Now that’s the theory. This is still preliminary. There’s a lot more research that needs to be done here.

But what’s also interesting about this study is that they look at the impact on crime and arrests and danger to officers and they find that there’s not an impact there. That crime rates didn’t get worse when you had a new DA, that there wasn’t more danger for officers, that there wasn’t more or fewer arrests which is actually an indictment of the prosecutor because hopefully you would want them to reduce arrest and incarceration, but that doesn’t seem to be happening overall in terms of new DAs.

But, again, this is preliminary research. I’m excited to learn more as more data comes out and more examination of the role that particular types of prosecutors can play in holding the police accountable. I know that looking at data from Mapping Police violence, there is a clear disproportionality whereby prosecutors who tend to charge officers with crimes after they’ve killed people are disproportionately Black prosecutors, or prosecutors who are disproportionately in sort of more progressive or left leaning areas.

So, again, I think we’re still starting to learn about the types of prosecutors, the types of people in particular roles and positions that are needed in order to hold the police accountable, in order to use those roles to reduce mass incarceration, to decline to charge people, as we’re seeing in some places, but not clearly not enough.

DE’ARA BALENGER: Sam, I was a little confused by this one, because I just feel like so much of why they think the reduction is happening– OK, so the DA gets elected and then crime goes down for a bit. But I just feel like the reasons for that– actually wish they would have surveyed some police officers, so like we could know a little bit more to the why. Because I just feel like these very smart people are putting very smart reasons behind why a police officer is doing what they are supposed to be doing. But I actually don’t know if I want to give them that much credit. Like I don’t know if a police officer who I’m sure has a record of misconduct is saying, oh, there’s a new DA, I’m going to take it easy right now.

Like I just don’t know if those sensibilities are like actual fact of how it would play out. So, I don’t know, like I saw this and actually read through, kind of skim through the really long paper on it and I kind of– and I don’t know this, is because it’s just my lawyer brain working, but I wish they would have said, we want to use this for this purpose. And then the narrative was driven by that. Because I think it’s just– it’s really confusing, because the headline is like, oh, that’s such a good insight. But then when you get into it, it’s like but do we really know the why? You know what I mean? Was that just me?

SAM SINYANGWE: Great question. And correlation isn’t causation, right? So there could be other factors that are influencing those trends. So looking at the why, like let’s say what is interesting about this, they didn’t survey police officers. But in surveys of police officers, I know like Pew Research Center has done surveys on thousands of police officers and looked at– like what do they think about criminal justice reform and police reform, et cetera. And what is interesting is like the police officer views are often like wild, like more overblown in terms of thinking that a given change will impact their profession or make it more likely for them to be held accountable than the actual data suggests, right?

So when you look at the data, like there are only a handful of prosecutors across the country that hold the police accountable when they kill people. Like full stop. Like it doesn’t matter if it’s a new prosecutor, an old prosecutor, like there are only a handful of prosecutors that really use their position to hold officers accountable and charge them after they have killed somebody. And that’s it.

So like the fact, there’s a new prosecutor doesn’t mean that there could be any more or less accountable. Right? And so this does seem like the police might actually be overreacting in a way that might be good for us because like they are not killing people. But we don’t know that without like that survey research, without understanding the mechanism that actually explains that relationship. But it is interesting because there’s been such a huge conversation about prosecutors and electing new prosecutors. And we do see some prosecutors using their position to make big changes in terms of reducing the number of people who are incarcerated, the number of people who are charged for low-level offenses, drug possession, things like that.

We also see a handful of prosecutors who are newer prosecutors who are charging police officers as well. Right? And so I think that there is sort of a potential for there to be a relationship there. But it would be so limited to a small number of places like to see an across the board impact on police violence would have to be like an overreaction on the part of the police.

DERAY MCKESSON: The space spends so much time trying to figure out how to deal with this problem. And maybe one of the things that is the biggest lever isn’t even like get a great DA, get a Black DA. They literally like any DA like literally just a new one actually might decrease it and like that was interesting. Not that I think that changes like overall strategy, but I think about even my experience in Baltimore or some other cities it’s like you do get these days who are there for 15 years. So the police– and this is sort of their argument– the police sort of get used to like they sort of what flies, what doesn’t fly and you get a new person and it takes time for the police to have to figure out like sort of what goes.

I know that was actually really interesting. There’s a case that I’m working on in Baltimore where like– yes, in Baltimore, there’s a do not call list, but I mean this case, the police lie all throughout the case. I mean, they just– and like clearly they keep getting called back. Right? Like they don’t lie too bad to not get call back or get punished. And I do think that that was really interesting to me, that like some of the things that we really do think are like the game changers might not actually be the game changers, and something as basic as like a new person, Black, white, green, progressive, not progressive, like literally the presence of a new DA actually might change the numbers in a really interesting way.

So that was interesting. It also made me think too that like we spent– the space spend so much time on electing progressive prosecutors, that the next phase has to be on like the policies in those offices like that we’ve sort of left that up to an even smaller group of people to press those policies. And it’d be interesting to think about how do we cement those policies, so that when the good person goes away, the policy remains, or it becomes a law or something like that.

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DERAY MCKESSON: My News is something I didn’t know about until this week. I didn’t know anything about nuisance ordinances. Like I didn’t know that was a thing that called chronic nuisance ordinances. And they are laws that allow or require a landlord to evict a tenant based on the accumulation of certain nuisances. So like how many times a police get called to a house for instance is one of them. I had no clue. I mean, it blew my mind.

And the reasons why this is wild are plenty. But when you think about domestic abuse survivors, that you could literally– your abuser can be like, hey, I’m going to call 911. And if you don’t do so and so, I’m like that’s why I didn’t know that. There’s not great research actually around the country to figure out like where these are. There’s some nominal research that shows that it is happening in some places.

And then there are some great scholars like we’ve had Matt Desmond on before he wrote a really good book called Evicted. He found that nearly a third of homes labeled a nuisance in Milwaukee recited based on domestic violence incidents and that properties in predominantly Black neighborhoods were 2.5 times as likely to receive a nuisance citation as properties in white neighborhoods. And this just was a reminder of the way that policing sort of intersects with housing justice and all those issues.

But also these things that are like– I feel like I eat and breathe this stuff and I had literally never heard of these before. And it blew my mind, like it truly was a thing where I was like I cannot believe that I didn’t know and we should figure out how to do something about it.

SAM SINYANGWE: So what was wild about this was it was just another example of one of these very small minor– literally, you have 911 called on your house twice or more and you get flagged for possibly being evicted. Right? So there’s this sort of dragnet or this web of ways in which you can sort of so easily slip through the cracks in the system and have major consequences.

So if you are for example, arrested and you are on parole or probation, right, and you just don’t show up on time for a probation hearing– all these technical violations small things low level offenses that actually make up the vast majority of what people are getting cited for, what people are getting arrested for, and even what people are getting jail for, and then having these lifetime consequences on housing, on access to health care, on access to food stamps, right, like all of these programs are tied to and you can lose access to them for having a conviction. In some cases for being cited right not, even sort of convicted of a crime or just like cited.

Or they just made up a new offense that isn’t even a crime, that can have major consequences for your life. So I think like what is wild about this is it’s hard to even track the extent to which this happens across the country because the existing sort of criminal justice statistics and databases don’t even track good data on citations, for example. So there is data on arrests, there’s data on crimes.

This didn’t seem to be a crime or an arrest. It was a citation that then results in somebody getting evicted, which would just completely not show up in any of these databases. And then when you even look at arrests, the single largest category of arrests in the Uniform Crime Report, which is the nation’s database for arrests, is all other offenses. So it’s just like a miscellaneous category of all these little things that actually have huge consequences for people, that we actually don’t have a good way of tracking across the country or understanding how acute they are or how severe they are in particular places, and which places I actually don’t do these things.

So like from a data perspective, this is a reminder it’s not the first story and probably won’t be the last of all of these things that you wouldn’t even have thought of, that could have major consequences for people. Because somebody just made up that if you call 9-1-1 on somebody’s house more than twice, like they can get evicted, like that is wild. That obviously, can lead to a lot of bad behavior and a lot of– for domestic abusers, is a real– like can be a real problem for people who are exposed to that kind of violence.

So, again, like this is obviously a bad idea. I don’t know what the oversight is on this like against not being tracked in terms of data. I don’t think it’s being tracked systematically in terms of policy. So like even like getting started here seems like a mountain to climb but a necessary one.

DE’ARA BALENGER: Well, I have two context for this. One is law school, obviously. But the second is just growing up in Hennepin County in Minneapolis, and how this is used incessantly in Minneapolis to target folks of color. Yes, I don’t know where we start. And I think what happens here is also akin to what happens generally in public housing or section 8 housing. It’s literally if you do this long list of things, you’re evicted, right? And some of these things are, yeah, calling the police because you feel like your life’s in danger or you’re witnessing a crime or whatever the case may be.

But– I don’t know– I think it’s also just one another instance of just the lack of humanity that we treat people who live at a certain economic level. And it’s just they are forgotten, they are abused, they are harassed. And to no end, and it’s not tracked. And there’s usually no recourse for them. And so, yeah, I think it’s one of those things that DeRay, I’m glad you lifted up, so people can understand that we start talking about inequity and it really existing and living in so many different aspects of one’s life. That this is an example of that.

My news this week is from an article in the New York Times which explores some of the ways that educators are planning to use the 129 billion allocated for schools from the federal stimulus legislation. As many people know, in March the Biden administration signed a federal stimulus package and it included $129 billion for schools to manage a recovery from this COVID pandemic. One of the big stipulations was that at least 20% of the federal funds must be spent on helping students recover academically from school closures and remote learning.

Lots of different districts and states are doing some interesting things. Some folks are hiring tutors to support young people in their academic recovery. Some are hiring more social workers and mental health counselors. Many districts and states are enlarging summer enrichment programming or reducing class size. They’re using the money to hire part time teachers, to pull out at risk students for specialized sessions.

They are deep cleaning their buildings and upgrading their ventilation systems. They’re increasing their base salary for staff, they’re extending the school year by 30 instructional days in some places and they’re funding summer field trips to places like Florida. The downside of all of this federal funding is that there are some complications with it. The biggest being time. We’ll talk about that in a second. And some unintended consequences.

So for many of the new hires, for example, they are being hired to do these new roles, but they are not being guaranteed long term positions because this is one time money, and this money will go away in 3 years. There are districts that need to replace aging school buildings, but that’s not an allowable expense for the money, even though they can do necessary improvements like upgrades. Some states and districts are offsetting drops in enrollments and budget shortfalls, they’re using this federal money to fill gaps. And some states are actually reducing statewide ed spending, because they believe that the amount of money districts are receiving from the feds is obscene.

And so, in fact, many districts have to in those cases use federal money to plug holes that are created by state legislatures who don’t believe that schools should get all of this money. In fact, that is a huge worry by a number of education leaders that the general public will think that schools are swimming in cash and not prioritize continued school spending, which means that state shortfalls will continue even when the federal funding does not continue, and that’s going to put us in a bad situation.

Some of our educators worry that students can’t fully make up for academic losses in the next three years, especially since the decline was most significant amongst poor students. And it’s going to take some time to really remedy the damage. But others argue that the timeline is more than generous and could even be shorter.

Yet there’s a subset of folks who feel like, OK, this is good, I can make good investments that will actually pay off. And it’s all up for grabs. We don’t know, we won’t know until we see how these things play out. But I brought this to the pod because I don’t know if the general public is aware of how much money schools are being provided for with the federal stimulus dollars. Schools are quite awash in money and this is an opportunity to take some risks, be creative and do some things that schools haven’t always been able to do to support young people.

And so my challenge to us all is as citizens– because this is our money, this is John Q. Public’s money– my challenge to us all is to keep an eye on how our schools are spending their stimulus dollars to be active and engaged in the conversation around communities demanding what they want to see for their young people. And being a critical friend to schools and school districts and states, when they are trying to spend things on priorities that don’t really reflect the needs of schools, we have a role to play in this conversation. And I am challenging each of us to be on our jobs and make sure that we are holding our schools and our school systems accountable for spending the stimulus money in the best way possible for kids.

DERAY MCKESSON: Hey, you’re listening to Pod Save the People. Don’t go anywhere, there’s more to come.

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DERAY MCKESSON: Hey, Pod Save the People listeners, there’s a new show that we think you’ll love and it’s called Written Off. It is an incredible podcast from Lemonada Media and Black Bar Mitzvah that shines a light on formerly incarcerated young authors.

DE’ARA BALENGER: It’s hosted by Walter-Thompson Hernandez, and each episode features an interview with a talented writer, while creatives like John Legend, DJ Ellis, and Keke Palmer perform their work. The voices of those locked up, some as miners, have been all but written off, but no more.

DERAY MCKESSON: Written Off, listen now or wherever you get your podcasts.

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And now my conversation with Professor Carmen Gutierrez. She’s a sociologist and she delves into the intersection between criminal justice, immigration systems and how public health and health care impacts all of it. We had a fascinating conversation about how the Affordable Care Act really changed health access for so many people who were incarcerated. Here we go.

Dr. Gutierrez, thanks so much for joining us here on Pod Save the People.

CARMEN GUTIERREZ: Thanks so much for having me, DeRay.

DERAY MCKESSON: Now, I’m super pumped to talk to you because you study a section of the work that I’ve been always interested in, but I didn’t know who to call. And it was like, oh, Dr. G, here we go. Help us understand what is it that you study.

CARMEN GUTIERREZ: Very broadly I study the ways that the US criminal legal system affects health and health disparities. And the way that I think about the criminal legal system also includes people’s experience with immigration, detention and deportation as well. So this broad system of people getting arrested, going to jail, going to prison or coming in contact with the police maybe through immigration policing as well, and how that affects people’s health outcomes, specifically people who are Black, brown and other marginalized groups that are disproportionately affected by this system. And not only them as individuals and how it affects their health, but also how it affects the health of their families and communities as well.

DERAY MCKESSON: Can you talk about the relationship between the Affordable Care Act Obamacare and incarcerated populations or formerly incarcerated populations? I think a lot of people would say like expanding health insurance access is a good thing, but what question whether even reaches people who have been so structurally denied access by the system. Does it matter? Does it not matter? Should we be fixing it in a certain way so that it matters more, given the sheer amount of especially Black and brown people who have been cycled through the carceral system?

CARMEN GUTIERREZ: So the Affordable Care Act, the way that it impacts folks who go cycle through the system, that was actually like what my whole dissertation was about. So I’ve been studying this for a long time. And so, basically, what’s interesting about the Affordable Care Act to me is that it sort of expanded health care to this group of people who have been ineligible for health care for like the history of health insurance in the United States. Before the Affordable Care Act, the way that we structured health insurance in the United States was primarily through the private industry.

So most people in the United States get health insurance through their jobs. That’s the biggest way that we provide health insurance. As an adult, I can also get health insurance if I’m married to somebody who has health insurance through their job. And so actually, before the Affordable Care Act women in the United States, adult women, just as many had health insurance through their marriage as had it through their own job, which I didn’t know before I started this work, but that was really interesting.

And then for other folks, low income people who might not have health insurance to their job or through marriage, could get health insurance through Medicaid if they had serial children. Meaning that they were a low income person who had a child under the age of 18. And so what this meant was that our health insurance system provided access through employment, through marriage and through children. And who this left out was unemployed, unmarried, childless adults.

And the intersection of those things overlaps significantly with people who go to jail and prison. Because who goes to jail and prison? Younger adult men who don’t have these links to society that provides them health insurance. So it’s sort of has been this backwards system that excluded systematically, people who went to jail and prison, who primarily are younger Black and brown men.

And so for a long, long time up until the Affordable Care Act, the only way that these group of men have been able to get health care on average, has actually been in jails and prisons, because in the United States, that is the only place that we have a constitutional right to health care. So since the Affordable Care Act was passed in 2014, the expansion of Medicaid, for the first time, made this group of unemployed, unmarried childless adults eligible for Medicaid.

And so what we saw in the first couple of years after the Affordable Care Act were these massive increases in health insurance coverage for people who have been recently incarcerated. Which was really very positive news. Before the Affordable Care Act, it was hard to estimate, but between like 50 and 90% of this population was uninsured. And that’s extremely dangerous for anyone to lack health insurance.

But for this group of folks, we happen to also know that they have extreme health issues that are also very complicated and complex, like high levels of chronic illnesses on top of high levels of mental illness, substance use disorders and just other really chronic health needs that the health care system should be addressing.

DERAY MCKESSON: Are there other barriers that is not just about like the legal ability to apply or get health insurance that people who are formerly incarcerated have to face or is it really just like now just like they can do it? Are there any other obstacles that felony convictions sort of bear down when it comes to health insurance?

CARMEN GUTIERREZ: The Affordable Care Act gave people more access to health insurance theoretically. But, of course, people are not automatically enrolled in health insurance, right? And so there are certainly lots of barriers that still exist, especially for formerly incarcerated people when it comes to gaining access to not only health insurance but also health care. Because health insurance does not equate to access to health care more broadly, right? It certainly helps people. It helps people pay for their healthcare, but it doesn’t get them in the door to see a doctor, right?

So when someone goes to jail and prison– let’s say that they had Medicaid because now they’re eligible, so they have coverage– but if they go to jail and prison, guess what? That Medicaid gets cut off. It’s not renewed while they’re behind bars.

DERAY MCKESSON: What does that even mean? Wait, it gets cut off.

CARMEN GUTIERREZ: Yeah, like if I am on Medicaid and I go to jail and prison, I lose my Medicaid coverage.

DERAY MCKESSON: And it doesn’t just restart when I get out?

CARMEN GUTIERREZ: That’s right. So technically, I don’t need my Medicaid coverage, I guess, behind bars, because I’m not accessing that health care system. I have a health care system guaranteed to me, it’s not a good one, right? But it’s something. Because I’m incarcerated, my Medicaid gets suspended.

As you can imagine, serves as a barrier because once people get out, they have a lot of things to worry about. Just like basic human needs of having somewhere to sleep, having food to eat all those things. We just have to assume that updating your insurance coverage is maybe not the first thing that you’re doing, right? And there’s not a lot of transition support that people have that helps them reinstate their benefits automatically and be insured again, which is something that should happen for them before they even leave jail and prison, in my opinion. It’s just that’s not what’s happening.

DERAY MCKESSON: Is anybody doing that right? Is there like a place where like when you get released, the state is like automatically making sure you have health insurance on the way out? Like is there a bright spot there or this is really just work we got to do?

CARMEN GUTIERREZ: I know that the state of California has done a lot to enroll people in health insurance for people coming out of jail and prison. I mean, I think it’s probably one of the best models that we have in the United States, certainly not perfect. But what’s kind of crazy is that California as a state has one of the highest, if not the highest, incarceration rate in the country. It’s like California and Texas are up there as incarcerating the most people in the United States.

Some years ago, California had issue with overcrowding in jails and prisons. And so the state enacted a realignment act at the state level, meaning that they had to deincarcerate, and I think their goal was to release you know hundreds of thousands of people from prison. And what that sort of did was like shift the responsibility of people in prison to a local level. What they’ve been doing to support the people that came out of prison was to help them get their benefits, because I think that they were recognizing that sort of a pathway into jail and prison is to be uninsured and to have health problems.

One could argue that it’s a determinant of prison, because the prison population has such significant health issues. Chronic illnesses, untreated mental illness and substance use disorders, high levels of disability as well. And so, if people are not getting access to what they need or treatment and they’re highly visible to the police, then it’s no surprise that they’re ending up in jail and prison. So California, because they’ve had to deincarcerate, have been doing a pretty good job of making sure that people get their benefits.

DERAY MCKESSON: And did any of this change during the pandemic? Like how has the pandemic– are you asking different questions because of COVID or is it sort of the same old, same old? Do we know anything about access to health care or just insurance during the pandemic with the population you study?

CARMEN GUTIERREZ: COVID, obviously, has been super devastating for people in jails and prisons specifically. The case rate is something like five times higher than the general population for people in prisons. The death rate is about three times higher at least from what we know. They might even be higher in reality. It’s just that the data we have is kind of limited. And that’s the nature of data on incarceration in general is it’s not always perfect.

So COVID has been terrible for people in jail and prison. In response to of maintaining the virus in jails and prisons, you might also know that most of the largest clustered outbreak in the United States have been in jails and prisons in the United States. It’s been one of the super spreader locations. And so a response to that has been to sort of deincarcerate again. So make sure we don’t have overpopulated jails and prisons.

Some places have been releasing folks and also diverting people from incarceration altogether, which is theoretically a very good thing for lots of reasons. And hopefully saving lives. At the same time, I don’t think that we are planning well enough for these folks while they’re in the community, and also they’re still being surveilled by the criminal legal system, right? They’re not just not going to jail and prison, now they’re on probation or parole, which means that they’re still connected to the system and experiencing consequences as a result.

We’re potentially, since COVID, increasing the number of people on community supervision instead of keeping them in jails and prisons and not necessarily giving them what they need. So we don’t know a lot right now about what it means to release people from jail and prison during COVID. Like we assume that they’re safer in the community than they are in jails and prisons, right? That’s the idea. But I don’t think we know.

And I’ll say that because research has found that certain groups who are incarcerated actually live longer in prison than they do in the community. All sorts of demographic groups go to prison, right? So men go to prison, women go to prison, white people go to prison, Black people, Latino people, et cetera, right? If you go to prison, you would maybe expect that it would hurt your life expectancy, because inside of prison can be violent, it can also be just a hostile, stressful environment that you would assume would actually maybe deteriorate your health, right? That’s kind of a reasonable assumption, I think.

But what’s been found, actually, is that on average, prisoners have longer life expectancies than the general comparative population. But when you break it down, what we find is that this is not true for women. So women don’t live longer in prison than they do on the outside. And it’s not true for white men, but it’s true only for Black men. We see that Black men in prison and on average live longer in prison than they do in the community. And what’s even more wild about this is that if we think about it sort of more generally, like we know in the general population that there are health disparities, right? Women live longer than men, for example, and we know that white people live longer than Black people on average.

The intersection of that shows that Black men have some of the shortest life expectancies in the United States. And on average, they live between four and seven years less than white men on average. And that four to seven year gap disappears in prison.

DERAY MCKESSON: My mind is blown. Is this because of the access to health care?

CARMEN GUTIERREZ: That actually to me is what motivated a lot of my research. Is it health care? I should also explain that this change in life expectancy is controlling for not just the fact that people aren’t dying in motor vehicle accidents, are not just dying because of homicides or this or that, right? So we’re controlling for other causes of death and we’re still seeing these outcomes. So why is that?

And I think it’s really important to know, though, that there’s lots of evidence that the health care that people get while they’re incarcerated is really bad. Like I don’t think we want to say that prisons are giving people really good health care, keeping them alive. This is like sort of scary to talk about because it could be twisted in so many ways. For some people who have really chronic illnesses that can be treated with modern medicine, like if I’m someone with chronic diabetes or kidney disease or something like that, then a basic provision of health care could be keeping me alive for years longer, and I’m getting that if I’m in prison, and I’m not getting that on the outside.

So the Affordable Care Act actually gives us an opportunity to better understand is it health care that’s keeping this specific group of men alive longer in prison? It’s wild.

DERAY MCKESSON: I’ve heard people say that the biggest mental health facilities in the country are prisons and jails.

CARMEN GUTIERREZ: Right.

DERAY MCKESSON: Do you know any of them that are well-run or like is there– because you think about what it means to just forget, obviously, we want to get rid of prisons and jails. And there’s such huge providers that you’re like, woo, like you at least want the services to not hurt people, given that there’s such huge providers. Is there a place that people are being serviced appropriately?

CARMEN GUTIERREZ: Unfortunately, I just don’t think that. I almost think that it’s sort of de facto that we’re keeping people alive more in prison. I don’t think that it was designed that way. It’s just sort of happening. And it speaks to how bad people have it on the outside more so than how good they’re getting it on the inside.

So I don’t know who is like a model for providing the best care for people. There’s so much variability I do know that I do think some places where they’ve sort of had to take it very seriously because of the overcrowding. Like I said, California I think has been sort of a model for lots of programs related to incarceration, in part because they’ve had to be. I think the state of Massachusetts has also done some more humane work with respect to incarceration as well.

But, again, there’s just so much variability and not a lot of oversight as far as I know. So someone who’s incarcerated in one state could be getting some level of care and it might look a lot different from their neighbor in the next state. There’s not a lot of documentation about it, which is scary. I think some other countries with different models are interesting to think about too.

DERAY MCKESSON: I thought that I read in your study this idea that coverage was equalized between the employed and unemployed, following the ACA.

CARMEN GUTIERREZ: Yeah.

DERAY MCKESSON: What does that mean and why does that matter or it doesn’t matter?

CARMEN GUTIERREZ: Employment has been the main pathway to health insurance in the United States for adults. We all are getting health insurance through our jobs most likely. The Affordable Care Act sort of helped people without jobs have this new pathway to insurance. We’re not necessarily required to have employment to have health insurance anymore. It’s made employment less significant in getting health insurance.

So what my study published in the American Journal of public health showed was that among recently incarcerated men, whether or not they were employed, no longer predicted their health insurance coverage after the Affordable Care Act, which was great. Because as you can imagine before the Affordable Care Act, employment was a much stronger predictor of health insurance. So there was this disparity in health insurance coverage that showed employed men had much higher levels of coverage than unemployed men.

After the Affordable Care Act, there was almost no difference between those who are unemployed and employed. And that’s really important for people who are formerly incarcerated, because employment as you know, for folks who were formerly incarcerated, can be really tricky. It can be really hard to get a job coming out of prison. There’s lots of not only formal discrimination but informal discrimination of people in the labor market due to their criminal records.

The fact that the Affordable Care Act made employment less important for folks in terms of their health insurance coverage is a really big deal in my opinion.

DERAY MCKESSON: Well, we consider front of the pod. And can’t wait to have you back.

CARMEN GUTIERREZ: Thank you so much. I really appreciate it. It was really great to talk to you, DeRay.

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DERAY MCKESSON: Well, that’s it. Thanks so much for tuning in to Pod Save the People this week. Tell your friends to check it out. Make sure to rate it, wherever you get your podcasts, whether it’s Apple Podcasts or somewhere else. And we’ll see you next week.

Pod Save the People is a production of Crooked Media. It’s produced by Brock Wilbur and mixed by Bill Lands. Our executive producer is Jessica Cordova Kramer and myself. Special Thanks to our weekly contributors, Kaya Henderson, De’Ara Balenger, and Sam Sinyangwe.

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