Why San Francisco's Sheriff Wants to Help Prisoners Sign Up for Obamacare

Helping ex-offenders get insured could have real public safety benefits. 

Image
REUTERS

Starting this month, states that agreed to the Medicaid expansion offered by the Affordable Care Act are required to expand Medicaid eligibility to include "all non-elderly low-income adults." That means many offenders who are leaving prison and jail will be eligible for health insurance for the first time. San Francisco Sheriff Ross Mirkarimi wants to make sure no offender leaves his jail without it. 

On Tuesday, Mirkarimi proposed legislation to the San Francisco Board of Supervisors that would require the San Francisco County Jail to help all arrestees apply for health insurance. "Inmates won't be eligible for coverage under the Affordable Care Act until they leave jail," reports the San Francisco Chronicle, "but the sheriff's move ensures they will have health care once they are released."

Mirkarimi believes that getting ex-offenders insured could help reduce recidivism by getting inmates access to addiction treatment and mental health care. America's jails and prisons are now serving the roles asylums once did, insofar as we send far more mentally ill people to prisons than we do to hospitals. Releasing them with health insurance could potentially keep mentally ill offenders from heading back to jail. So there's an obvious public safety benefit to Mirkarimi's proposal. 

But even offenders who aren't mentally ill likely need health insurance. By some estimates, 85 percent of U.S. prisoners suffer health problems, and while it's difficult to pin down exact figures on the rates of uninsured offenders when they first become incarcerated, by all accounts it's extremely high (Mirkarimi has cited a figure of 90 percent in county jails, though we were unable to verify that number).

Allowing those offenders to continue treatment once they've been released would also, Mirkarimi argues, reduce emergency room visits and health care spending. That claim is harder to prove. The Washington Post recently reported on a study that showed expanding Medicaid coverage in Oregon via a 2008 lottery actually increased all types of health care usage—including emergency rooms. Which is to say, people on Medicaid saw their primary care doctors more, but they also went to the ER more. If you feel bad, and treatment's paid for, why not go? 

Unsurprisingly, people opposed to Obamacare aren't thrilled about adding felons to the Medicaid rolls. Beyond acting humanely to help a population whose job prospects have been greatly diminished, there's a very good reason to provide health care to ex-offenders. "Prisons have high rates of hepatitis C, HIV and tuberculosis," observes Pew's Stateline. "Untreated former prisoners carry those diseases into communities on the outside and spread those infections."

Top image: Inmates at the San Francisco County Jail. REUTERS/Stephen Lam. 

About the Author