Can Obamacare Reduce the Cost of Corrections?


Amy Solomon

The Affordable Care Act (ACA) has the potential to dramatically reduce costs associated with incarceration and prisoner re-entry, a U.S. Department of Justice (DOJ) official said yesterday at a conference on health care and corrections at the John Jay College of Criminal Justice in New York City.

Local and federal governments spend about $80 billion annually on corrections — about $35,000 per inmate, but Amy Solomon, an advisor to the DOJ's Office of Justice Programs, noted that those receiving continuing healthcare beyond incarceration are significantly less likely to be re-arrested.

Beginning in 2014, Americans who earn up to 133 percent of the federal poverty line and reside in 25 states that have agreed to a Medicaid expansion will qualify for access to the government insurance program. Those who earn up to four times the poverty line will qualify for federally subsidized insurance.

For impoverished former inmates re-entering their communities, Solomon said that could mean their first opportunities to pursue healthcare beyond bars.

“Continuity of care is essential if we want to see health and safety benefits,” Solomon said.

Despite widespread technological issues associated with ACA websites in the past month, the healthcare overhaul often referred to as Obamacare will ultimately help reduce recidivism and lower the cost of providing medical services to those leaving prison, said Solomon.

“Is rollout going to be perfect? We know the answer to that one,” Solomon said. “But this is a long-term game.”

Millions of Americans spend time in local jails each year and 670,000 state and federal prisoners are released to their communities annually. While inmates have a constitutional right to healthcare, Solomon said, many come from and return to poor communities where their treatment fails to continue.

And for communities struggling with the ravages of addiction, mental illness and other issues often relegated to the corrections system, it could mean opportunities to find less costly alternatives to incarceration.

“I hope judges will have viable community-based treatment options, so they won't feel compelled to lock up someone with mental health issues,” Solomon said.

The key to diverting would-be inmates is separating low-risk offenders from those who are a high-risk, according to Elizabeth Glazer, former deputy secretary for public safety at the New York State Office of Criminal Justice Services.

In New York State, 8 percent of offenders account for 80 percent of crime, Glazer said at the conference.

“The question becomes, does everybody taking up an expensive prison bed have to be there?” Glazer said at the conference. She added that the key to figuring that out is performing risk and needs assessments for inmates at each step in their involvement with the criminal justice system — from arrest to release — in order to determine if the best solution might be mental health care, substance abuse treatment or another option beyond prison.

“If the majority of the incarcerated are low risk, perhaps it means that incarceration should be the alternative,” Glazer said.

But for both low- and high-risk inmates currently in prison, the task of meeting healthcare needs upon release can be tricky. Few continue care with the provider they had in prison and healthcare often drops off entirely.

New York recently unveiled a program called Medicaid Health Homes, which is designed to facilitate communication between all of an individual's caregivers. For inmates re-entering local communities after prison stays, Glazer said the result will be an increased continuity of care.

“Done right, fewer people are going back to jail and prison, and that's sort of where the bigger incentive is,” Glazer said.

Graham Kates is Deputy Managing Editor of The Crime Report. He welcomes comments from readers. He can be found on Twitter @GrahamKates.

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