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March 10, 2014

"Little-Known Health Act Fact: Prison Inmates Are Signing Up"

The title of this post is the headline of this front-page New York Times article.  Here is how it gets started and additional excerpts:

In a little-noticed outcome of President Obama’s Affordable Care Act, jails and prisons around the country are beginning to sign up inmates for health insurance under the law, taking advantage of the expansion of Medicaid that allows states to extend coverage to single and childless adults — a major part of the prison population.

State and counties are enrolling inmates for two main reasons. Although Medicaid does not cover standard health care for inmates, it can pay for their hospital stays beyond 24 hours — meaning states can transfer millions of dollars of obligations to the federal government.

But the most important benefit of the program, corrections officials say, is that inmates who are enrolled in Medicaid while in jail or prison can have coverage after they get out. People coming out of jail or prison have disproportionately high rates of chronic diseases, especially mental illness and addictive disorders. Few, however, have insurance, and many would qualify for Medicaid under the income test for the program — 138 percent of the poverty line — in the 25 states that have elected to expand their programs....

Opponents of the Affordable Care Act say that expanding Medicaid has further burdened an already overburdened program, and that allowing enrollment of inmates only worsens the problem. They also contend that while shifting inmate health care costs to the federal government may help states’ budgets, it will deepen the federal deficit. And they assert that allowing newly released inmates to receive could present new public relations problems for the Affordable Care Act. “There can be little doubt that it would be controversial if it was widely understood that a substantial proportion of the Medicaid expansion that taxpayers are funding would be directed toward convicted criminals,” said Avik Roy, a senior fellow at the Manhattan Institute, a conservative policy group....

In the past, states and counties have paid for almost all the health care services provided to jail and prison inmates, who are guaranteed such care under the Eighth Amendment. According to a report by the Pew Charitable Trusts, 44 states spent $6.5 billion on prison health care in 2008.

 In Ohio, health care for prisoners cost $225 million in 2010 and accounted for 20 percent of the state’s corrections budget. Extended hospital stays — treatment for cancer or heart attacks or lengthy psychiatric hospitalizations, for example — are particularly expensive Stuart Hudson, managing director of health care for Ohio’s Department of Rehabilitation and Correction, said his department, which plans to start enrolling inmates in Medicaid when they have been in the hospital for 24 hours, expects to save $18 million a year through the practice, “although it’s hard to know for sure, because there’s other eligibility factors we have to keep in mind.”

Nancy Griffith, Multnomah County’s director of corrections health, said the county expected to save an estimated $1 million annually in hospital expenses by enrolling eligible inmates and passing the costs to the federal government. More money could be saved over the long term, she added, if connecting newly released inmates to services helps to keep them out of jail and reduces visits to emergency rooms, the most expensive form of care. “The ability for us to be able to call up a treatment provider and say, ‘We have this person we want to refer to you and guess what, you can actually get payment now,’ changes the lives of these people,” Ms. Griffith said.

Rick Raemisch, executive director of Colorado’s Department of Corrections, said that billing Medicaid for hospital care would save “several million dollars” each year.  But as important, he said, was the chance to coordinate care for prisoners after their release. About 70 percent of prison inmates in the state have problems with addiction, he said, and 34 percent suffer from mental illness.

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Under 123D, these $billions would be saved. All repeat offernders would be gone before age 18.

When one of these is loosed on the hapless public by the traitor lawyer, he causes $10's of millions of damage to real estate values, generates $millions in cost by spawning dozens of bastards by different women.

Then, the lawyer calls his fictitious adjudicated charges non-violent, when he has actually dispatched dozens of competitors, and is a serial professional killer.

This is a major catastrophe, because getting high and committing many crimes weekly has tremendous advantage of over treatment. The lawyer has made the risk of crime so low, and the consequences so mild, there is no way of leaving the crime world for the rational human being. These are not only rational, they are more sophisticated than the lawyer. They have played him for the biggest con job in history, getting the lawyer to betray the public interest and to work hard for the interests of the criminal.

Posted by: Supremacy Claus | Mar 11, 2014 1:45:05 AM

I worked hard for the interests of all of my criminals.

Posted by: Liberty1st | Mar 11, 2014 2:04:59 AM

"There can be little doubt that it would be controversial if it was widely understood that a substantial proportion of the Medicaid expansion that taxpayers are funding would be directed toward convicted criminals"

Well, that would be true if the statement was a fair one, which it is not. I am quite sure his definition of substantial is set at a much lower bar than the ordinary person's meaning of substantial.

Posted by: Daniel | Mar 11, 2014 2:56:39 PM

I don't know if this is the right way to go about it, but in some systems there is an appalling reluctance to allow prisoners to go to outside hospitals for necessary procedures, due to cost. We can argue about whether this is an appropriate expenditure of federal funds, but it may actually reduce the incidence of borderline cruel and unusual medical care in prisons, by removing the financial disincentive for prison doctors to give access to necessary hospital care. (Of course some of the states with the worst prison medical care rejected the federal money to expand Medicaid, so maybe the effect will be limited...)

Posted by: anon | Mar 12, 2014 11:18:13 AM

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