Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1991. He currently practices law in Tulsa and represents clients at the Capitol.
The latest state-by-state comparison for incarceration rates drew headlines in Oklahoma because we are now number one in incarceration. Rounding out the top ten after Oklahoma are Louisiana, Mississippi, Georgia, Alabama, Arkansas, Texas, Arizona, Kentucky and Missouri. A quick view at the list suggested the question of whether there is a correlation between incarceration rates and Medicaid expansion, so I decided to look.
I found that six of the ten highest incarcerating states have refused to expand Medicaid coverage: Oklahoma, Mississippi, Georgia, Alabama, Texas and Missouri. Louisiana adopted a "demonstration" version of expansion like the Arkansas plan, effective July 1, 2016. Since then it has dropped from Number one to Number two. Arkansas, on March 4, 2014 adopted its private option version of Medicaid expansion. Arizona adopted a private option version of Medicaid expansion but 42 percent of the state's 773,000 uninsured are eligible but not enrolled in Medicaid due to certain barriers; Kentucky had one of the more successful transitions to Medicaid expansion although it recently changed to a private option plan.
So, six of the ten states highest in incarceration have not adopted Medicaid expansion. Three of the other four states have a private option version of expansion, which suggests something less than full-throated support. Kentucky has now gone that route. So, what does this prove? Health care and criminal justice are both complex topics, so it's dangerous to draw conclusions without a lot more research than I'm capable of. Certainly, there are reasons beyond failure to expand Medicaid that will explain the high incarceration rates in these states. Kentucky, for example is one of only six states that, like Oklahoma, still has jury sentencing in criminal cases.
Medicaid expansion makes substance use disorder and mental health treatment available to thousands of people — namely women without children and men — who do not otherwise have a way to get treatment. Everyone, regardless of political stripe these days says a major driver of the incarceration rates is lack of available treatment. Governor Fallin and legislators have wrangled for four or five years with "criminal justice reform" and struggled to find money to provide treatment. I would argue that common sense says the correlation between lack of treatment and incarceration is significant. One answer for the problem seems obvious: accept our own federal treatment dollars that are available under Medicaid expansion. It's a shame that stubbornness by some and political fear by others keeps an acknowledged solution from being available to those who become incarcerated — and to their families and their victims.
The post A connection between the nation’s highest incarceration and refusal to expand Medicaid? (Capitol Update) appeared first on Oklahoma Policy Institute.
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