Americans with criminal backgrounds--including inmates, parolees, and people on probation--comprise more than one-third of those eligible for health insurance through Medicaid expansion under the Affordable Care Act, according to a recent Forbes column by Avik Roy.
The figure comes from a 2011 U.S. Justice Department estimate published in the Federal Register. The agency noted about 10 million Americans are either incarcerated or let out of prison annually. If about 60 percent of them are uninsured and fall within the required income range, and the Medicaid expansion will cover about 16 million Americans, then at least 35 percent of the Medicaid expansion population consists of convicted criminals, Forbes reported. It's an off-the-radar but controversial data point.
A growing number of prisons are helping inmates enroll in Medicaid both while incarcerated and in preparation for their return to the community, as FierceHealthPayer reported. And many states could save millions annually on correctional healthcare services by expanding Medicaid, according to results of an October 2103 study by the Pew Charitable Trusts.
Though former inmates have high rates of mental illness, addiction and chronic health problems, few have health insurance, according to The New York Times. Many uninsured inmates leave prison with a 30-day supply of medication and must fend for themselves when it runs out. Medication lapses may contribute to the likelihood of later criminal activity, the Times reported.
Moreover, a 2009 Washington state study found low-income adults who received addiction treatment had fewer arrests than those who didn't, the Times noted. And giving newly-released inmates access to healthcare services may decrease recidivism and emergency department use. Yet experts agree that having health insurance doesn't guarantee that prior offenders won't commit future crimes.
This raises program integrity and policy questions. "Medicaid is an especially expensive, and inefficient, and ineffective program rife with waste, fraud, and abuse," Roy wrote. "You can be sure that there are plenty of taxpayers who work hard and play by the rules, who are wondering why they should pay more in taxes for this purpose. It's certainly not what they were told they were paying for when Obamacare was passed."