July 22, 2024

Health: Does health insurance impact recidivism rates?


Recidivism is determined by crimes committed within three years of a person's release that led to a new arrest, conviction, or return to prison with or without a new sentence…

What is recidivism? 

Recidivism is determined by crimes committed within three years of a person’s release that led to a new arrest, conviction, or return to prison with or without a new sentence.

Research funded by the NIJ on sentencing, corrections, and assessments of policy interventions all incorporate recidivism research. In order to inform probation and parole policy, many NIJ-funded research of community supervision rely on recidivism measurement.

Consideration of recidivism is crucial when examining the fundamental criminal justice issues of incapacitation, targeted deterrence, and rehabilitation.

While general deterrence effects refer to the influence of punishment, the term “specific deterrence” is frequently used in the literature on crime to explain the effect of punishment on the future behaviour of offenders. Since a person’s experience with jail as well as the presence of a criminal record may affect them to view the threat of punishment differently than they did prior to being convicted, there are numerous reasons to expect these impacts to differ from one another, as described in the literature. Because it enables us to separate the specific deterrence impacts of having access to health insurance from its potential deterrence effects, focusing on recidivism is particularly crucial.

Studies that concentrate on crime rates are unable to distinguish between specific and general deterrence effects since changes in these rates are caused by a combination of both. Therefore, without additional investigation, it is impossible to determine if a particular decrease in crime is the result of recidivists committing fewer crimes or if the policy is more effective against first-time offenders. 

This distinction is important when comparing the merits of various strategies, such as those that target inmates being released from jail against those that aim to lower crime overall. We may find a solid candidate for cost-effective crime reduction strategies by isolating the specific deterrence effects of improved access to health insurance, namely prison-exit policies that governments can use to reduce recidivism. 

Over the past few decades, the United States has seen rising rates of incarceration. The number of people behind bars increased between 1980 and 2016 from 503,600 to 2,162,400 (USDJ, 2018). Minorities make up the majority of those behind bars, especially adult males of colour (Kaeble and Cowhig, 2018).

Most people who cycle in and out of prison have high rates of chronic illnesses, significant mental health difficulties, and drug use problems (Bronson and Berzofsky, 2017). Numerous people do not obtain critical medical care while they are detained or after being released, despite the necessity for immediate and consistent access to care (Wilper et al., 2009). Health insurance restrictions place a hurdle in the way of reintegration into society, which raises the likelihood of recidivism.

Does health insurance impact recidivism rates?Source: Google Images

In this essay, we investigate the relationship between public health insurance and recidivism. Access to high-quality care depends in large part on having health insurance. This is crucial for those involved in the judicial system since they frequently reenter jail uninsured and with behavioural health problems already present (Mallik-Kane and Visher, 2008). We take advantage of a policy change in the majority of states that extended public coverage to low-income adults in 2014, known as the Affordable Care Act’s (ACA) Medicaid expansion, to assess the impact of health insurance on the likelihood of reentering jail.

The inclusion of services for mental health and substance use disorder (SUD) as essential health benefits is a related provision of the ACA. As a result, beginning in 2014, all plans offered through the Marketplace or through Medicaid to ex-offenders will include coverage for mental health and substance use disorder services, including behavioural health treatment.

Our primary conclusions emerge from the observation that the perception effect is bigger than the income and well-being effects, which is consistent with the fact that violent and public order crimes have decreased more dramatically than property crimes. A thorough examination of our hypothesis offers several compelling justifications for this outcome. It specifically demonstrates a significant mechanical advantage of perceptual effects over well-being and income impacts. The cost of committing crime rises probabilistically as a result of the well-being impact. 

An individual loses his (improved) well-being if he is found guilty of a crime and must serve time in prison. Furthermore, if the policy changes that result in greater access to health insurance also increase the likelihood or quality of medical care that a criminal can receive, lowering the cost of punishment, the well-being effect may actually be adverse.

Similar to this, the income effect works by decreasing the marginal benefit from additional income from property crimes. However, this reduction is only significant if the offender is not apprehended because if he is, he forfeits the benefits of increased health coverage in addition to his criminal advantages. Additionally, the extent of the income effect is dependent on a person’s level of risk aversion, which is rising.

An ex-income offender’s effect will be negligible if they exhibit minimal risk aversion or act in a risk-neutral manner. Contrary to these findings, a person’s perceived benefit from committing a crime is reduced without regard to detection and is unaffected by their level of risk aversion. Instead, it decreases the value of the uncertain prospect of committing a crime.

We find that the expansions reduce recidivism for both violent and public order crimes using administrative data on prison admission and release records from 2010 to 2016. Additionally, we discover that the public coverage expansions significantly boost access to treatment for substance use disorders. The impact is most noticeable for those with Medicaid coverage who are sent to treatment by the criminal justice system. These results are most in line with the hypothesis that improved access to healthcare lessens the perceived non-financial rewards of crime for ex-offenders. 


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