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Supreme Court: Health Reform Decision

The June 28, 2012 ruling by the Supreme Court to uphold the Patient Protection and Affordable Care Act preserves the extension of health care coverage to millions of Americans, including the large population of non-violent offenders with mental illness and chemical addiction who cycle in and out of our nation’s jails.

The decision affirms the expansion of Medicaid to an estimated 16 million newly eligible people on the basis of low-income status, without regard to pre-existing conditions, or to whether they belong to select categories of poor, such as being a woman of childbearing age, having serious disability, or being elderly.

The newly eligible Medicaid population includes some of society’s most vulnerable members. COCHS anticipates that there will be significant overlap between this population and the jail-involved population, which is disproportionately young, male, minority, and poor, with comparatively low levels of educational achievement. Ninety percent of those who enter jail have no health insurance.

The jail-involved population also tends to be sicker than the general population on measures of both physical and behavioral health. This population has high needs for health care but little or no access to insurance or community health care services. Instead, these individuals tend to seek and receive treatment when they are in crisis—in emergency rooms and in jail—rather than getting preventive or routine care from community safety net providers such as community health centers and clinics. This kind of everyday primary care and disease management could actually help reduce recidivism.

COCHS will continue to work with our partners to build connectivity between jails and community health care providers in anticipation of Medicaid expansion. We will work at the local, state, and federal levels to identify issues and stimulate discussion among stakeholders as they develop policies that create and expand access to care for the population involved with the criminal justice system.