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Medicaid expansion’s uncounted benefit

schmidt

When I served on the Governor’s first workgroup that studied and recommended Medicaid Expansion for the State of Idaho, I sat on the panel next to a former director of the Idaho Department of Corrections. I had previous experience working as a physician in the Idaho prisons and we had discussed this in the past.

After one long day of presentations from experts with graphs, tables, numbers and projections as we were getting up from our chairs to go he bent over and whispered to me, “I hate that Obamacare, but this Medicaid expansion would sure be a benefit for my guys.”

I nodded, but after he left I wondered if he meant by “my guys” the recently incarcerated and released, or the guards who work at the prison. Knowing the low pay for prison staff, he may have meant both.

The next day when the summary was being provided about the costs and benefits of Medicaid expansion, I asked the expert if they had figured in any savings from criminal justice costs. They said, no, such calculations would just be too hard to do. I argue they would be substantial. You can’t count what you don’t see.

People in custody (county jail or state prison) are not eligible for Medicaid health insurance to pay for their health care. That cost comes right out of the Idaho general fund. Right now, the charge for folks in prison is over $16/day, almost $6000 per prisoner per year; a total of $48M dollars a year we can’t spend on schools or roads.

My short time working as a doctor in the Idaho prison taught me a lot. I was expecting to see lots of healthy young men with a history of behavioral and substance issues. I was surprised how many middle aged and older inmates there were with chronic disease. Over 65% of the inmates were on chronic medications; many were on psychiatric meds. Imagine what happens to these folks when they are released to the community with no access to health care and a $6000/year health care habit. We are being stupid about how we treat people. Idaho pays 100% of their health care costs in prison, then because they are not eligible for health insurance in Idaho, we pay 0% when they are released. If we expanded Medicaid eligibility we would pay 10% of the costs. Seems a good investment to me.

Right now, the legislatures Justice Reinvestment Oversight Committee (JROC) is hearing testimony from “experts” as to why we need to spend $500M to build a new prison here in Idaho. That’s what the Board of Corrections has recommended. Prosecutors are saying, “It’s not our fault our prison population is exploding. We are just enforcing the laws you legislators write.”

The easiest, cheapest recommendation the JROC could make to the legislature and the governor, easier than sentencing reform, cheaper than building a new prison, would be to say what the former director said to me: “We hate that Obamacare, but expanding Medicaid would sure be a good thing for our people.”
 

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