Medicaid for Felons

by Jillian Kay Melchior

Freed felons will be newly eligible for the Medicaid rolls, another unpleasant surprise in Obamacare. Pew’s Stateline reports:

Starting in January, many of the 650,000 inmates released from prison each year will be eligible for something else: health care by way of Medicaid, thanks to the Affordable Care Act.

A sizeable portion of the nearly 5 million ex-offenders who are on parole or probation at any given time will also be covered.

Before, in most states, former prisoners weren’t eligible unless they were pregnant or disabled. But now:

Beginning in January, states that agree to the Medicaid expansion will be required to provide Medicaid to all non-elderly low-income adults. For the first time, many of the 5 million ex-offenders on parole or probation will be eligible for the assistance. It applies to those released from either state or federal prisons. The exceptions will be former prisoners living in those states that currently have limited Medicaid eligibility for adults and that ultimately opt out of the Medicaid expansion, a choice accorded the states in the U.S. Supreme Court’s ACA ruling last June.

Expect it to be an expensive addition. In 2010, Pew found that “serving time reduces hourly wages for men by approximately 11 percent, annual employment  by 9 weeks and annual earnings by 40 percent,” meaning many will be eligible for Medicaid by virtue of their income levels.

There’s not much upward mobility, either: “Of the former inmates who were in the lowest fifth of the male earnings distribution in 1986, two-thirds remained on the bottom rung in 2006, twice the number of those who were not incarcerated.”

Moreover, as Stateline’s article notes:  

[Former inmates] have higher rates of chronic and infectious disease (in particular, asthma, hypertension, tuberculosis, diabetes, hepatitis and HIV/AIDS), addiction and mental illness. . . .

In the first two weeks after release, the rate of death among former inmates was more than 12 times greater than the rate for the general public. The leading causes of death for the ex-cons were drug overdose and cardiovascular disease.

Obamacare expands Medicaid enrollment substantially. To deny someone enrollment because he’d served time in prison would surely violate the underlying intent of giving everyone equal health care. And if affordable health care is now a right, to deprive former felons would be to impose a punishment in addition to their original sentence. So to some extent, felons’ new Medicaid eligibility makes legal sense.

But there’s nevertheless an annoying hypocrisy here.

As Bloomberg’s recent soda campaign so aptly demonstrated, once health care becomes a public expense, personal choices become a public concern. Taxpayers can expect to be nagged about small poor life choices like opting for a bigger beverage or a higher-calorie meal choice.

But monumental poor life choices, including the ones felons have made — which result in lower incomes and worse health — will be subsidized by those same taxpayers.

It may be equal, but it doesn’t seem very fair.

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