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Inmate Health Care—Changed By ACA, And How It Affects Society

Luigi Caterino/

A side effect of the Affordable Care Act has been a trend of jails and prisons signing up inmates for Medicaid, according to a recent New York Times article. Scott Allen, M.D., co-director of the Center for Prisoner Health and Human Rights at Brown University, speaks about why those who become incarcerated tend to have higher risks of certain physical and mental health problems, why society should care about the health of those in prison and more. 

Health problems faced by those in US jails and prisons

“The population that fills US prisons and jails comes from largely at-risk populations for chronic disease. And actually, across the spectrum, we see higher rates of common disorders such as diabetes, asthma, and other conditions.  But there are several categories that really are overly represented. The first area is infectious diseases, things like HIV and Hepatitis C, which are seen at much higher rates in the incarcerated population. And secondly, the area of mental health; Chronically mentally ill are also disproportionately represented in US jails and prisons. And finally, those with chronic addiction.”

Treatment for inmates  

“These same patients, when they are in the community, historically have not had access to care. So, in general, at least it provides the opportunity to diagnose conditions; maybe start treatment; maybe stabilize; and in the case of addiction, depending on the facility, there’s relative sobriety… In general, in the short term, there could be improvements in health. The problem, of course, is that people don’t usually stay in prisoners forever. And the vast majority, rotate right back into the community.”

On how the Affordable Care Act affects prisoners

"Historically, all health care provided in prisons was typically self-insured. The state prisons simply paid the medical bill for every cost of medical care without going to an insurer. The vast majority of people out of prisons were not covered by insurance, and had they been covered by a government program, it lapsed as soon as they left the prison. Under the ACA, there will be new opportunities both through public programs but also in some cases by people who secure private insurance through the exchanges to potentially seek reimbursement through those programs while the person is incarcerated. That’s one way the Affordable Care Act may have an impact on correctional health. Probably just as important, is new opportunities for people with chronic illness leaving prison now potentially being able to secure insurance coverage, where again, historically, they haven’t been able to. Historically, people who’ve been incarcerated weren’t eligible for a number of the public programs, and rarely were in a position to afford third party insurance on the private market. And that’s important, because a very high-risk period of health wise comes when people with chronic illnesses are leaving prison."

Why should the public care?

“Just thinking of it just from a public policy and a fiscal policy point of view, taking a population, or subset of the US population, that’s highly affected by chronic illnesses and trying to address those illnesses in the most cost-effective way should be of interest to everyone. It’s tempting to think of the jail and prison population as an isolated population that is locked away and someone else’s problem, but the vast majority of people who are incarcerated return to the community. On any given day in the United States, there’s between 2 and 2.5 million people incarcerated at any given moment. And over the course of a year, about 10 million people rotate through jails and prisons. So the majority of people who’ve been in contact with the criminal justice system are actually out in the community.”