If Missouri Republicans really want to reduce crime, a new research paper suggests a strategy:
Stop trying to limit the benefits of Medicaid expansion.
In August 2020, Missouri voters expanded Medicaid to cover a larger percentage of poor people in the state, particularly adults who don’t have children. The Show-Me State was late to the game, following years of opposition by Republicans in the Legislature, who didn’t believe study after study that showed the expansion was good for the economy.
Despite voters doing what lawmakers wouldn’t, Republicans are trying again to put an initiative on the ballot to undo the vote. Last Wednesday, a Senate committee advanced the proposal, which has already passed the House. Democrats, and a few brave Republicans, notably Sen. Lincoln Hough, R-Springfield, are opposed.
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Just a couple of days before the vote, a group of researchers at the Antonin Scalia School of Law at George Mason University published finding that trying to stop Medicaid expansion is a bad idea. Their conclusion should give Republicans an important reason to stop their misguided plan.
Expanding Medicaid reduces crime, the researchers found.
“A recent and expanding body of work finds that increased access to health insurance generates sizeable indirect benefits due to its crime reducing effect,†wrote the researchers, Erkmen G. Aslim of Grand Valley State University; Murat C. Mungan, of George Mason; and Han Yu, of the University of Memphis. “Here, we add to this scholarship by estimating the marginal value of public funds associated with providing Medicaid to exiting inmates, and find that doing so generates benefits that are at least three times as large as the net-costs of providing Medicaid and are in all likelihood much greater.â€
As the researchers note, their findings should not be all that surprising. A growing body of work shows that Medicaid expansion pays for itself, by increasing employment and the tax base and reducing health-care expenses.
What makes this study different is that it focused on people coming out of prison. The researchers determined that having access to health care created an environment that reduced crime.
“We find that Medicaid expansions reduce the average number of times a released inmate is reimprisoned within a year by about 11.5%,†the researchers wrote.
Why? The study finds “reduced criminal harm due to reductions in reoffenses; direct benefits to former inmates from receiving Medicaid; increased employment; and reduced loss of liberty due to fewer future reimprisonments. Net-costs consist of the cost of providing Medicaid net of changes in the governmental cost of imprisonment; changes in the tax revenue due to increased employment; and changes in spending on other public assistance programs.â€
In Missouri, even with Medicaid expansion approved by voters, getting needed health care to men and women as they leave prison involves obstacles that don’t exist in other states. suspend Medicaid for those people who qualify for the program, after a conviction, during the time the person is in prison. But that means, once they get out of prison, their access to Medicaid is turned back on immediately. That offers immediate help for people who might need mental health care services or help with drug addiction, for instance.
Not so in Missouri, where Medicaid is canceled after a felony conviction. Upon leaving prison, a person in Missouri has to re-apply for Medicaid services — a process that can take a month or longer. Advocates have complained in the past year that delays during the expansion process have made it difficult for poor people who now qualify to actually get the health care they deserve.
If Missouri Republicans are successful in undoing the expansion that voters fought so hard for, then many people leaving prison won’t even qualify. Before expansion, Missouri’s Medicaid requirements were some of the strictest in the country, leaving hundreds of thousands of adults living in deep poverty unable to access the health care they needed.
The result, if Missouri rescinds the expansion, according to the latest research?
More crime. More unemployment. More costs for taxpayers.
It is as though the researchers are speaking directly to the Missouri Republicans who are on a path toward increasing crime rates in the state, simply because they can.
“The indirect benefits associated with expanding health insurance ought to be considered in contemporary health policy debates,†the researchers wrote, “and counsel in favor of policies whose effect would be an expansion of access to public health insurance for exiting inmates.â€
More health care. Less crime. When it comes to Medicaid expansion, that’s the debate the Missouri Legislature should be having.
Tony Messenger • 314-340-8518 @tonymess on Twitter tmessenger@post-dispatch.com