The study concluded that spending increased in 42 of the 44 states studied. Median growth of 52 percent, but in 12 states, prison health expenditures at least 90 percent. Texas and Illinois experienced inflation-adjusted decreases in their prison healthcare costs.
The main reasons behind the rising costs? More prisoners thanks in part of mandatory minimum sentencing guidelines and the unmitigated failure of the war on some drugs. A failure except for the prison industry, that is. Over the past four decades, the U.S. inmate population has risen by 677 percent, from 198,061 in 1971 to 1,538,854 in 2011. The other factor is the aging of that prison population. In 1999, only 43,000 prisoners were over age 55. Now, 121,000 are. Those older inmates with chronic diseases average two to three times that of the cost for other inmates, according to Pew.
Starting next year, as part of the Affordable Care Act, the federal government will cover 100 percent of the costs new Medicaid enrollees in those states that choose to expand Medicaid to cover all adults earning up to 133 percent of the federal poverty line, which for an individual is currently $15,282. The federal share of expanded Medicaid coverage will be reduced to 90 percent by 2020. Twenty-five states and the District of Columbia have decided to expand Medicaid. Almost every prisoner would qualify for coverage.
Reducing inmates' health-care impact on state prison budgets would not be the only benefit, according to Amy Solomon, an adviser to the U.S. Department of Justice’s Office of Justice Programs. The expansion of Medicaid will also cover ex-convicts, many of whom live in poverty. Providing Medicaid for former inmates not only should improve their health, Solomon says, but also could reduce recidivism associated with addiction and mental illness, much of which now goes untreated among ex-prisoners.
For those still incarcerated, Medicaid would only cover health costs incurred when inmates are sent to hospitals and other health-care facilities outside the prison walls. But such costs can be substantial. In Ohio, for instance, where Republican Gov. John Kasich out-manuevered members of his own party to expand Medicaid, savings for inmate health care during the first eight years of the expanded Medicaid are estimated at $273 million.
Dennis Smith, the former director of the Center for Medicaid under President George W. Bush, ain't happy about this idea:
"By definition, those state prisoners in state facilities are the obligation of the state and that obligation should not be transferred to the federal government ... I think most people would come down on the side that Medicaid was never intended to pay for the medical care of people in state custody," Smith said. "It's a very significant issue for the federal budget and Congress better close that loophole quickly."There is, of course, an additional way to cut expenditures for inmates' health care. Reduce the number of prisoners by ending the drug war that has put so many of them in the slam in the first place.