A new report issued by the Square One Project of Columbia University predicts that if the Supreme Court strikes down the Patient Protection and Affordable Care Act (ACA) when it rules on California v. Texas, an unintended outcome will be higher incarceration rates because the ACA Medicaid expansion will be terminated. Without access to Medicaid, formerly incarcerated individuals will be left uninsured and unable to obtain health care services needed to manage chronic health conditions, such as mental illness or addiction disorder. The Supreme Court heard arguments on California v. Texas on November 10, 2020. A ruling is expected in the spring of 2021.

The Square One Project report, “Understanding Health Reform as Justice Reform: Medicaid, Care Coordination, and Community Supervision,” was written by Lynda Zeller and Jackie Prokop. It analyzes how state parole and probation systems serve formerly incarcerated individuals with chronic health conditions, with a focus on how justice and public safety rely on offender access to health care. They argue that justice reform strategies to reduce mass incarceration will not be successful without health care and social supports for persons with chronic health conditions.

Ms. Zeller said, “Health and justice are so closely intertwined that we cannot effectively reduce mass incarceration without ensuring access to health care. Individuals with chronic health conditions will continue to be over-represented in the justice system, suffer high rates of re-incarceration, and remain incarcerated for longer periods of time if they do not have access to adequate health care. This report offers policymakers a playbook on how to better serve these individuals and our communities while saving money by harnessing the power of existing investments in health care and reducing mass incarceration.”

The ACA Medicaid expansion allows states to offer Medicaid to a new category: uninsured, low-income adults ages 19 to 64 who are not otherwise eligible for Medicaid and who have income below 138% of the federal poverty level. Since 2014, 38 states and the District of Columbia have expanded Medicaid or passed ballot measures to implement the expansion.

The issues in California v. Texas focus on whether the ACA can stand without the penalty tax to enforce the “individual mandate” to obtain health insurance on those who remain uninsured. In 2017, Congress set the tax to zero, essentially eliminating the penalty. If the Supreme Court determines that the ACA is unconstitutional without a tax greater than zero to enforce the individual mandate, then all provisions of the ACA will also be struck down.

The report is posted at https://squareonejustice.org/paper/understanding-health-reform-as-justice-reform-by-lynda-zeller-and-jackie-prokop-november-2020/ (accessed November 22, 2020).

This was reported by The Square One Project on November 10, 2020.

Contact information: The Square One Project, 475 Riverside Drive, Suite 316J, New York, New York 10115; Email: info@squareonejustice.org; Website: https://squareonejustice.org/