The headline: “Good News for Felons: Obamacare Will Insure You!” draws a predictable gamut of reactions, from “Who Cares?” to “Why Cover Them?” We Americans are not soft on crime. Most victims of burglary, robbery, or far worse want to “lock ‘em up and throw away the key.” Ditto for families of victims. The rest of us who see the recaps of mayhem, murder, and robberies in the media feel the same “lock ’em up” way.
As a nation, we do lock ’em up: 2.3 million Americans are behind bars – compared to 1.5 million people in China; 890,000 in Russia (2008 data). Our rate of incarceration is 750 per 100,000 population; in Germany, it is 93 per 100,000. For black men ages 20 to 34, jail or prison is almost a rite-of-passage: 1 in 9 serve time, compared to 1 in 30 men, overall. In terms of being “tough on crime,” we are number one.
Yet we do not throw away the keys. Most inmates leave within 3 to 5 years, allowing for good behavior and probation; and more than half of “released offenders” return within 3 years for new crimes or violations of the terms of their release. We churn them in and out. Yesterday’s burglar is today’s inmate, tomorrow’s parolee, and, often, a future felon who will cycle back to jail. For some inmates, prison marks a turning point. For others, it is a way-station.
We release prisoners largely for economic reasons: “corrections” saps taxpayers’ money. We pay for buildings, staff, and inmates’ room-and-board. States pour money into “corrections” at the detriment of “education,” “roads,” “sanitation” — the other budgetary drains.
We also pay for inmates’ health care. Not surprisingly, inmates are sicker than their non-institutionalized cohorts. Many enter with hepatitis, hypertension, HIV, depression, psychoses, tuberculosis, and addiction, as well as diabetes and asthma. Often inmates start medication regimens while behind bars. Some physicians see penal sentences as an opportunity for genuine treatment. Some inmates receive better care in prison than they did in the community.
Before the Affordable Care Act, once inmates, including those on probation or parole, left prison, they left their healthcare system: no more access to physicians, no more pharmacy dispensing pills, nobody monitoring their health. And, generally, unless they were lucky enough to land a job with benefits, they had no health insurance. Medicaid did not routinely insure single men, the largest group of ex-convicts. They were simply not eligible.
Those released prisoners, though, were still ill, still needed medication, still were infectious. If they sought help anywhere, they went to emergency rooms or public clinics; but those providers were not reimbursed.
The Affordable Care Act changed the rules. Now adults younger than age 26 can be insured under their parents’ plans. Or states can extend insurance to single unemployed poor adults through Medicaid or through one of the state exchanges.
In keeping ex-convicts healthy, we are not just helping them. We are helping all of us.
Consider the benefits of insuring released prisoners.
We will stanch the red ink of hospitals and public clinics.
We will increase ex-convicts’ chances of landing mainstream jobs. On release, most men have no job, no supportive family (often, their friends and family try to draw them back into their pre-prison modus operandi), no money, no home (landlords do not welcome them). Ill health cements their fate.
By treating ex-convicts’ mental illness and addiction, we will discourage the criminal acts that feed their drug habit, discourage their asocial behaviors.
By treating their infectious diseases, we will keep those diseases from spreading.
And maybe we will stop the churning of prisoners; maybe we will no longer lead the world in incarceration.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.
From The Progressive Populist, July 1-15, 2014
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