Every year, 650,000 Americans are released from jail. Upon departure, there are few reasons to be nostalgic - except when it comes to health care.
In prison, an inmate is guaranteed access to health services, thanks to the eighth amendment of the United States Constitution, which prohibits cruel and unusual punishment. The U.S. National Commission on Correctional Health Care has created a set of standards for jailing institutions to follow to ensure that the prison is not in violation of the constitution.In most penitentiaries, prisoners receive wellness exams including an annual pap smear for women and a once every three years physical for men; medications for chronic conditions or mental disorders; and, treatment for drug or alcohol addiction. In the case of a major medical concern requiring hospitalization or specialized services such as surgery, the prison will arrange for such care to be provided to the inmate at a very low co-pay of as little as five dollars.
When ex-offenders leave incarceration, however, this access to comprehensive, limited-cost health care disappears. In the case of medication, prisoners may be given a two-week supply of drugs, but lack the means to refill their prescription once this cache has run out - after all, many criminals went into jail with few resources, and will have even fewer upon release. Limited financial assets can mean a lack of interest in seeking health services or continuing on medications which were started in prison; what's more, the employment available to newly-released felons is usually poorly paid, and rarely includes health insurance.
The good news for ex-felons and their advocates is that health care for former prisoners is about to get a lot better - starting in January 2014, many states will expand Medicaid, and a good proportion of these newly-covered citizens will be ex-felons. Thanks to the Affordable Care Act, states that have agreed to take money from the federal government and enlarge their Medicaid insurance program will begin offering health care to all adults who are between 19 and 65 years old, and make a salary of up to 138 percent of the federal poverty level. Around five million ex-felons currently reside in the United States, many of whom fall into this low-income category.
Advocates for ex-felons say that expanding Medicaid and offering better health care to former prisoners is an important step toward not just improving the health of these individuals, but the wellness of communities around the country. Viral infections such as HIV and Hepatitis C occur at a much higher rate amongst members of the prison population, and without proper treatment once released from jail, these diseases can more easily spread. Research from the Rand Corporation has shown that prisoners are nine times more likely than an average member of the general public to be infected with HIV, and ten times more likely to suffer from Hepatitis C.
Better access to health care through Medicaid should further help ex-felons, and the states in which they reside, by increasing access to mental health services. In 2009, the American Journal of Public Health reported that nearly 69 percent of inmates leaving prison use anti-psychotic medications; if these prescriptions are abruptly stopped upon losing access to prison health services, dangerous side effects can occur. With Medicaid, however, ex-felons requiring psychiatric help will be able to continue with their medication, receive the support of a therapist, and get help in controlling negative or illegal behavior.
Post-prison therapy can also be beneficial for former inmates trying to break an addiction to drugs or alcohol. Without the continuation of addiction therapy that most prisons offer, a former user runs the risk of returning to dependence upon illegal substances. Addiction to drugs or alcohol can lead to poor overall health for the ex-felon, and the kind of criminal activity that affects everyone in his or her community.
Although some Americans are less than thrilled at the prospect of ex-felons being rewarded by Obamacare, proponents of the Medicaid expansion point out that better health care for former prisoners will save money in the long run. At the moment, many uninsured ex-felons avoid visits to the doctor and general wellness care in an effort to save money; instead of an annual check-up, these people will wait until a health problem has become so severe that an E.R. visit is necessary. At that point, if the patient does not have the funds to cover whatever care is received, the cost of services will go back to the taxpayers. With Medicaid, however, an ex-felon or other low-income American can confront chronic health conditions such as diabetes and asthma, instead of relying on an expensive trip to the Emergency Room. The National Institute of Health estimates that around 41 percent of prisoners suffer from at least one chronic disease, and so access to medication and other regular health services is of the utmost importance to keeping this part of the general population healthy.
Of course, not every state will be providing this expansion in Medicaid coverage - thanks to a ruling by the Supreme Court last year, each state is allowed to choose whether or not it would like to receive federal funds and help in order to expand its Medicaid program. Idaho is one of a few states which is as of yet undecided on Medicaid expansion, and one public radio project in that state ran a very interesting story earlier this month on how one man, an ex-felon, might be personally affected by Idaho's decision. StateImpact talked with Mitch Ponting, a man who is hopeful that Idaho will agree to expand the state's Medicaid program so that he can continue with the medication he was prescribed in jail, including prescriptions to cope with arthritis and mental health issues. If Idaho does expand Medicaid, another 100,000 people will receive coverage.
Despite understandable reservations about paying for the health care of former criminals, there is simply no way to separate a law abiding, low-income citizen from a low-income citizen who once broke the law. And, in the end, it does seem rather silly to provide better health services inside rather than out of prison.