The Affordable Care Act and Ex-Cons: Increasing Access to Care May Reduce Crime and Racial Disparities

A recent report by the Sentencing Project examines opportunities the federal Affordable Care Act (ACA) presents to reduce the number of people with mental illnesses or drug addictions who cycle in and out of the criminal justice system.  (About half of the prison population has a mental health diagnosis; 65% meet diagnostic criteria for alcohol or other drug abuse or addictions.)  Because these conditions are associated with criminal behavior, the report suggests that barriers to community care indirectly affect crime and recidivism rates.  And it notes that racial disparities in the criminal justice system have been tied to disparities in access to community-based health care.

In 2010, one-third to three-quarters of men booked into jails in 10 major cities had limited access to community health care, in part because they were uninsured.  Explanations include:  (1) difficulties finding and holding down jobs (thus limiting access to employer-sponsored health insurance) and (2) restrictive Medicaid eligibility rules.

The ACA creates new options that may reduce these barriers.  It requires states to have health insurance exchanges up and running by 2014.  Exchanges will act as regulated marketplaces offering policies to low- to-moderate income people without insurance.  Participants will qualify for tax credits on a sliding scale to offset costs.

The act also allows states to offer Medicaid to everyone under age 65 with income below 138% of the federal poverty level.  It requires health benefits for the new group to include prevention, early intervention, and mental health and substance abuse treatment services.

The report recommends that states planning and implementing ACA changes consider the benefits of (1) including outreach to disadvantaged groups involved in, or at risk for involvement in, the criminal justice system; (2) coordinating care between community- and corrections-based providers; and (3) capitalizing on mental and substance abuse treatment services to divert people from the criminal justice to the health care system.