Obamacare goes to jail

Some individuals in West Virginia and across the country who currently or will be receiving free or subsidized health insurance under Obamacare are now behind bars.

According to a story last month in the New York Times, “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.”

Lawrence Messina, Communications Director for the Department of Military Affairs and Public Safety, which oversees West Virginia’s prison system, says the ability to have Medicaid cover hospitalizations for prisoners after 24 hours actually dates back to 1997.  States either weren’t aware of the policy exception or are just now taking advantage of it because of how the new federal law encourages expansion of the eligibility threshold.

West Virginia is in the early stages of utilizing the program. Messina says between 60 and 70 state prisoners and regional jail inmates were hospitalized between January and March for durations that now qualify for Medicaid coverage.   The state will pay the bills, then apply for reimbursement from Medicaid.

Corrections officials estimate the program will save their agency up to $3 million out of next fiscal year’s General Revenue fund budget, but it’s really a cost shift.  The federal government initially picks up 100 percent of the cost of newly enrolled Medicaid recipients under ACA, but that share declines to 90 percent by 2020.

Messina says the second phase of the program, which is just getting underway in West Virginia, identifies those who may be eligible for Medicaid when they get out of jail.  “This phase remains in-the-works,” Messina said in an email, “and so we’re not far along enough to say how these released inmates might enroll.”

The Times reports, “People coming out of jail or prison have disproportionally high rates of chronic diseases, especially mental illness and addictive disorders.  Few, however, have insurance and many would qualify for Medicaid.”

Opponents of ACA predict when taxpayers learn of the prison-to-Medicaid program, they won’t be happy.  “There can be little doubt that it would be controversial if it was widely understood that a substantial portion of the Medicaid expansion that taxpayers are funding would be directed toward convicted criminals,” Avid Roy, a senior fellow at the Manhattan Institute, a conservative policy group, told the Times.

But supporters of the program, including West Virginia Corrections Commissioner Jim Rubenstein, believe health insurance for parolees will help pay for needed substance abuse treatment.

Rubenstein says substance abuse is a major driver of criminal behavior, including recidivism.  He believes Medicaid coverage could prove a critical difference by offering these individuals needed treatment or counseling.

The Times reports that health experts “believe up to 35 percent of those newly eligible for Medicaid under Mr. Obama’s health care law are people with histories of criminal justice system involvement, including jail and prison inmates and those on parole or probation.”

Prisoners and parolees need health care too, and it’s reasonable to argue that getting them enrolled may help deal with the expanding and expensive problem of substance abuse.  However, Obamacare is already unpopular among a wide swath of America.  The news that ACA includes health insurance for law breakers will make it an even tougher sell.





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