States which exercised the option to expand Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA) experienced a 3% decrease in the annual rate of reported crimes compared to non-expansive states, according to an analysis of crime data figures between 2010 and 2015.
The study found that the reductions in state-level crime rates were largest in counties that experienced the largest changes in insurance rates following the expansion of Medicaid eligibility in 2014.
The study, entitled “Access to Health Care and Criminal Behavior: Short-Run Evidence from the ACA Medicaid Expansions,” tracked figures from the FBI Uniform Crime Reports and the Census bureau since the ACA removed restrictions on treatment for states that chose to expand Medicaid eligibility, and based eligibility solely on income.
According to figures cited by the study author, Jacob E. Vogler, a Ph.D. candidate in the Department of Economics at the University of Illinois at Urbana-Champaign, of the estimated 15 million individuals newly eligible for Medicaid coverage under the ACA, one third had prior criminal justice involvement.
Under the Medicaid expansion, these individuals could receive coverage for a wide range of treatments for mental illness, substance use disorders, and chronic diseases.
Approximately 70 percent of individuals with a criminal history have a substance use disorder, mental health issue, and/or serious physical medical condition. These conditions may lead to criminal behavior and incarceration without adequate insurance coverage.
“While high rates of uninsurance and criminal behavior separately impose heavy burdens on individuals and communities in the U.S., statistics also indicate that the issues are closely linked,” said the paper.
Vogler’s analysis found that since 2014, violent crime rates in expansive states saw an overall reduction between 4% and 5%. Property crime rates in these states also saw an overall reduction of 3%.
He estimated that the reduction resulted in an annual costs savings of nearly $400 million.
The research compared the 31 states and the District of Columbia which have adapted Medicaid expansion to the 19 states which had not. As well as state-level crime data obtained from the FBI’s Uniform Crime Reports for 2010-2015, the paper used county-level data obtained from the Interuniversity Consortium for Political and Social Research UCR Program Data Series.
Social cost savings were calculated by combining inflation-adjusted cost estimates with the estimates number of reduced incidents of crime.
Founded in 1965, Medicaid is the largest means-tested social insurance program in the country. States have a great deal of autonomy when determining program generosity, creating heterogeneity in Medicaid requirements across individual states.
The Medicaid reform was originally formulated to apply nationwide, but was effectively made a state option by a 2012 Supreme Court ruling on the constitutionality of the ACA.
Future research is essential as the long-term impact of health insurance eligibility on criminal activity remains unknown, the author said.
A full copy of the report is available here.
This summary was prepared by TCR intern Brian Edsall. Readers’ comments are welcome.