Prison Inmates Enrolling in Medicaid Spark Debate on Whether Those Enrollments Count

The latest in Obamacare controversies: Inmates are eligible for expanded Medicaid, which means prisons can pass inmate health care costs on to the federal government

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The latest in Obamacare controversies: Inmates are eligible for expanded Medicaid, which means prisons can pass inmate health care costs on to the federal government. As the New York Times explains, prior to Obamacare, counties were responsible for all health care costs, including expensive long term hospitalizations. But with the Medicaid expansion, which now allows childless adults to enroll, Medicaid will pay for long-term hospital care.

Medicaid only covers convicted criminals serving time if they're hospitalized off site over 24 hours, but those are the most expensive costs — the Ohio prison system estimates they'll save $18 million a year in hospitalizations alone, according to a February Bloomberg report. Those costs will shift to Medicaid, which is funded by the federal government. Inmates will also stay insured after being released, which isn't the case for most inmates now.

Several other counties across the country are either running similar programs or considering them. Fox News called it "outrageous," and Newsmax described the benefits of the program as: "giving prisoners Obamacare coverage inflates enrollment numbers for the program and allows states and counties to avoid paying for expensive hospital stays."

That argument ignores the benefits of insuring prison inmates. As the Times points out, prisons have high concentrations of people with addiction and mental health issues that benefit from consistent care, and those with addiction problems are "significantly" less likely to return to crime, and return to jail, if they receive treatment. The idea of "felons" on Medicaid fits perfectly into the narrative of Obamacare taking from those who work hard and giving to those who are lazy, dishonest, and the dredges of society.

It also challenges the right's burgeoning new debate on prison reform: lower recidivism and make sure those who commit crimes get help. “You want to talk about real conservative governance? Shut prisons down. Save that money,” said Rick Perry during a CPAC panel. “Stop the recidivism rates—lower them." He mentioned transferring addicts to treatment centers, not putting them in prison — health insurance would cover that treatment. And while there are valid concerns over whether Obamacare is equipped to handle inmates costs that should be covered by states (it's not) those aren't the concerns being addressed. 

The main problem is that there's a sense among conservative bloggers that the enrollments of prison inmates don't count, and will just inflate the popularity of the program. As one conservative blog put it, "Are they really that desperate to boost the sagging enrollment numbers?" The Daily Mail argued that this tactic is "frustrating for some Republicans who don't want to see the success levels of President Obama's signature law inflated artificially." And one Republican aide told the Daily Mail:

We just found out that Obamacare is going to cost $2 trillion over 10 years. Now we’re going to have local governments picking our pockets to pay for their jail inmates? What a disgrace. It makes you wonder, when the president gets excited about enrolling a few million people, how many of them are criminals?

On the one hand, a pre-trial prison inmate signing up for Medicaid from her cell doesn't show the same level of support and interest as someone not in jail logging on to At the same time, uninsured inmates make up 35 percent of those newly eligible for Medicaid, and 90 percent of those who are or have been in jail are uninsured, according to the Times. There's a lot of overlap between people who benefit from the law and people who have been to prison.

Outside of that, it's been established that most new Medicaid enrollments aren't the direct result of Obamacare, despite what the administration would have you believe. The important number is the number of private insurance enrollments, and most inmates and paroles can't afford the plans, even with subsidies. Prison inmate enrollments won't "inflate" the number of private insurance enrollments. 

Another talking point is that Obamacare enrollments are an attempt to increase the number of registered Democratic voters ahead of the primaries and 2016. Here's how Newsmax made that connection, based on the National Association of Counties encouraging counties to enroll inmates (emphasis added):

NACo, which represents 3,068 counties across America, is one of the "Big 7" state and local government lobbying groups, all of which push to expand the size and scope of government, conservative critics say.

Production of NACo's March 2012 briefing booklet was funded by the left-wing Public Welfare Foundation, headquartered in Washington, D.C ... A prominent member of the Public Welfare Foundation's board, nonprofit consultant Shirley Sagawa, served on President Barack Obama's transition team in 2008.

The argument here is that regardless of whether the inmates benefit from Medicaid, this move is about expanding the "size and scope" of the government. Even The Daily Caller is hinting at this ulterior motive — it pointed out the George Soros (the right's shadowy billionaire equivalent of the Koch brothers) is funding the group helping enroll prisoners in Cook County, Illinois.

This article is from the archive of our partner The Wire.