Medicaid expansion under Obamacare is a really good deal for states. That we already knew—the states will spend less on picking up the tab for the uninsured and will have to cover much less critical, expensive care because of it. That's a part of the savings, but here's another part that doesn't get a whole lot of coverage: States can save prison costs by expanding Medicaid to cover incarcerated people.
In California, where prisons are some of the most expensive in the country, it costs around $47,102 a year to house an inmate, and over a quarter of these costs are for health care alone. It costs the state a far lower sum—just $3,558—to provide an individual with Medicaid. Even in states with lower prison costs, keeping an inmate in jail usually costs tens of thousands of dollars, while the national average cost for states to provide one person with Medicaid is just $5,352.Expanded access to health care—particularly mental health and drug rehabilitation services—can also help newly released inmates stay out of prison. Think Progress notes that Maryland has demonstrated this, showing an 11 percent drop in the rearrest rate since it implemented a program for increased access to health services. Most people coming out of prison will probably be eligible for expanded Medicaid, if the state has implemented it, giving one more stepping stone to help rebuild a stable life outside of prison.
And that Medicaid cost can be offset even further by lowered emergency room costs. Emergency room visits, which previously-uninsured Americans often use in the place of regularly seeing a health care provider, are extremely expensive. But when low-income inmates have access to insurance, they may go to emergency rooms less. Reports coming out of the Transitions Clinic, a program that started in 2006 to help newly released prisoners access health services, show that people who went to the clinic had 50 percent fewer visits to the ER than people who didn’t go to the clinic.
From a fiscal standpoint, Medicaid expansion is as much of a no-brainer as it is from a moral standpoint. There's no good reason for governors and legislators to refuse it. There's just one really bad reason: politics. ln most of the red states, it seems to win every time.