Why ObamaCare is the perfect prescription for prison reform

When Speaker of the House Paul Ryan (R-Wisc) announced on Friday that ObamaCare had become “the law of the land,” the biggest winners of the Repeal-and-Replace Fail were the Koch Brothers, and not only because they opposed the American Health Care Act (AHCA). 

The Brothers Koch are leaders in justice and sentencing reform; ObamaCare’s continuing reign might be some of the best support they have for that agenda.

On the eve of the first scheduled vote, the billionaires pledged millions – through their various political action committees –  in contributions to those representatives who would vote no on the what was being called “TrumpCare,” the replacement for the Affordable Care Act.

{mosads}This wasn’t because they wanted to keep the current healthcare statute. The Koch’s think that the AHCA didn’t go far enough in eliminating former president Barack Obama’s healthcare reform. There’s no dispute that the brothers Koch have helped catalyze the current movement toward criminal justice reform. They co-sponsored – with the ACLU, no less –  the first ever Bipartisan Summit on Criminal Justice Reform in Washington almost two years ago to the day.


The Kochs graciously invited me and their event was the start of my work in prison issues; I had been released from York Correctional Institution a year earlier and sat in the audience imagining how much harder my life – which certainly wasn’t easy – would have been as a returning citizen when no one was talking about reentry and redemption.

I listened to the unlikely pairing of Van Jones of #cut50 and former Speaker of the House Newt Gingrich explain that, while the fiscal waste of mass incarceration attracted many conservatives to the issue of reform, many on the right were drawn to justice reform by its moral imperative to rehabilitate and re-assimilate our fellow Americans as they exited prisons or courtrooms with felony convictions.

In many ways, I’ve felt indebted to the Koch’s for the last two years because they spent millions to highlight issues I was experiencing at the time. I needed the redemption they were endorsing.

At the Summit, Jones and Gingrich were joined, either in person or by video, by many of the members of Congress who will be voting on ObamaCare’s replacement, to promote the goal of: “safely and smartly cut[ting] our prison population in half over the next 10 years.”

Perhaps they haven’t noticed, but these voting congressmen and women should know that this is exactly what ObamaCare has been doing. The five states with the largest enrollment under the Affordable Care Act – Georgia, North Carolina, Florida, Texas and Pennsylvania – also lead the way in reducing both prison populations and crime significantly between 2010 and 2015

The average drop in prison population among those five top ACA jurisdictions was 8.52 percent, with Texas whittling away 12.9 percent of its inmate count. All five states witnessed a significant decrease in crime, averaging a 19 percentage point drop, Texas again besting other states by reducing crime 23.3 percent. 

The connection between ObamaCare and public safety improvements shouldn’t surprise us that much. Not only is the Affordable Care Act good for people diagnosed with mental illness because the law expanded the parity for medical and mental health problems and required small group and individual insurance plans to cover mental health, it’s good for people suffering from substance abuse problems and addiction.

The Department of Health and Human Services estimated that, under ObamaCare, 32 million Americans accessed access mental health and substance abuse care that was denied them before the law went into effect.

And because access to drug treatment directly correlates with a reduction in violent crime, it would make sense that insuring the greatest number of people protects even more people from becoming victims of crime.

No moral imperative is motivating the Koch’s hardline on the Obamacare repeal-and-replace; they didn’t want the American Health Care Act or “Trumpcare” voted down out of concern for the criminogenic effects of causing 24 million people (according to the most recent Congressional Budget Office estimate) to lose health insurance. Rather, to these Republicans, the Medicaid expansion of the Affordable Care Act is its worst provision and it needs to go.

True justice reform advocates know that the Affordable Care Act’s Medicaid expansion is a cornerstone of crime control, because successful reintegration of prisoners depends on physical, mental and substance abuse treatment availability.

Approximately 641,000 people leave prison every year, according to a report released this month by the Prison Policy Initiative. At one time, those individuals accounted for one third of the uninsured population – 70 to 90 percent of released offenders left custody to no healthcare coverage.

This changed under the Affordable Care Act because a significant number of childless, single adults – people like me –  left custody and were able to meet with a healthcare provider as soon as they could secure an appointment. 

When Medicaid expansion started in 2014, released prisoners received the mental health and substance abuse counseling that they needed and were often required to undergo as a condition of their supervised release.

Because recidivism isn’t measured regularly, we don’t yet know how exactly much this expanded coverage reduced reoffending, but experts predict that it will.

If nothing else, the continuity in care that released prisoners can enjoy won’t ruin health investments made in prisoners while they are incarcerated. At the very least, ObamaCare doesn’t make the billions spent on incarceration a total waste.

Justice reform advocates concentrate on Barack Obama’s record clemency grants and the fact that he was the first acting president to visit a prison, but the greatest criminal justice reform of the past administration may have been its signature healthcare law: crime and incarceration go down when more people are insured.

Anyone who seeks a total, irreversible replacement of the Affordable Care Act also seeks to destroy all of its benefits, which happen cure the criminal justice ills they are complaining about.

Someone needs to tell Charles and David Koch that they can either champion criminal justice reform or they can support a complete ObamaCare repeal, but they can’t do both.

Chandra Bozelko served more than six years in the maximum-security York Correctional Institution, Connecticut’s only women’s prison for nonviolent crimes that remain on appeal. She is the author of Up The River: An Anthology. Her writing has appeared in the Wall Street Journal and the National Review. She is a 2017 John Jay – Harry Frank Guggenheim Criminal Justice Reporting Fellow, focusing on indigent defense under the Trump Administration.

The views expressed by contributors are their own and are not the views of The Hill.

Tags ACA ACHA Barack Obama Crime Mental health ObamaCare Paul Ryan Prison Substance abuse TrumpCare
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