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ACA: Crime Fighter?

Obamacare may pay unexpected dividends by helping reduce crime.

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Ron Sanders may hold the record for the fastest round trip from and back into jail. Released after a year in a San Francisco county lockup, he headed back to the streets he knew best. "Four hours after I got out, I got me a 40 [ounce bottle of malt liquor] and a rock of crack," says Sanders. "Then I turned around, and there was a cop right behind me." He was back behind bars before the day was over.

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Slightly slower-paced versions of Sanders' story play out every day, all across the country. An astonishing two-thirds of the 730,000 men and women released from America's lockups each year have either substance abuse problems, mental health problems, or both. Very often, those problems were largely responsible for getting them locked up in the first place. Most addicted and mentally ill prisoners receive little or no effective treatment while they're incarcerated or after they're turned loose. So it's little surprise that, like Sanders, they soon wind up back in jail. But for some, that revolving door may stop spinning this year, thanks to a little-noticed side effect of the Affordable Care Act (ACA). Obamacare, it turns out, might be a crime-fighting tool.

Numerous studies support the common-sense notion that treating offenders' drug addictions and mental illnesses helps keep at least some of them from going back to jail. Get that junkie off heroin, and maybe he won't steal your car stereo for fix money; get that mentally ill homeless person on proper medications, and maybe she can find a job instead of turning tricks in alleys.

But no one has been willing to pay for treatment for hundreds of thousands of ex-cons. And they certainly can't afford it themselves: According to a recent report by the Council of State Governments, the vast majority of released prisoners reenter society with little money and no health insurance. Now many of those former prisoners are eligible for insurance, courtesy of the ACA.

Among many other reforms, the ACA drastically expands Medicaid, the federal insurance scheme for the poor. Previously, able-bodied childless adults were generally not covered by Medicaid, regardless of how impoverished they might have been. But starting this year, any American citizen under 65 with a family income at or below 138 percent of the federal poverty line — about $25,000 for a family of three — is eligible for Medicaid (at least in the two dozen states that have so far agreed to participate in this aspect of Obamacare). This could mean that thousands of the inmates released every year are now eligible for health insurance, including coverage for mental health and substance abuse services.

Providing treatment to those former prisoners could yield enormous benefits for all of us. The average cost to incarcerate someone for a year is roughly $25,000. So, if only one percent of each year's released inmates stay out of trouble, taxpayers will save nearly $200 million annually — and the pool of troubled ex-cons looking to steal your car stereo will be that much smaller. "Success in implementing the Affordable Care Act has the potential to decrease crime, recidivism, and criminal justice costs, while simultaneously improving the health and safety of communities," says a recent report by the Department of Justice.

But there are significant obstacles to making this work. One is the simple fact that many former prisoners aren't even aware of their new entitlements. Making services available is one thing. Getting people whose judgment isn't that great in the first place to actually use the services is another. Plenty of drug users and mentally ill people don't want to admit they have a problem. And many former inmates need more than just treatment to keep them straight — basics like decent housing and a job are also critical.

Government agencies, public health officials, and prisoner support organizations across the country are working to connect inmates with Obamacare. Illinois Governor Pat Quinn has formed a working group targeting the issue. Massachusetts has implemented an electronic Medicaid application system for inmates leaving incarceration. Similar efforts are underway in California, Maryland, and other states.

Even the most determined outreach campaign won't succeed in enrolling every single former prisoner, and not all of those who enroll will bother getting treatment. But at least some will get the help they need when they are sent back out on the streets. That should save them a lot of trouble — and the rest of us a bundle.

Vince Beiser is a California-based writer who contributes to Los Angeles Times Magazine, Rolling Stone, and LA Weekly.

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