The Build Back Better bill is a transformative piece of legislation. And if it can be salvaged after Senator Joe Manchin abruptly tried to end negotiations with his party over the bill, it could be the cornerstone of Joe Biden’s presidency, given its ambitious policies tackling climate change and bolstering the social safety net. Also wrapped up in the bill’s fate are its lesser-known provisions — small tweaks and improvements to existing programs — many of which could similarly improve people’s lives in tangible ways.
One of those small-scale items that was latched onto Build Back Better is the Medicaid Reentry Act — a proposal to allow Medicaid to start covering people who are serving their last 30 days in jail or prison. Under the current system, prisoners are barred from receiving Medicaid coverage, even if they were on the program before they were incarcerated. And as is often the case, getting back on the social program proves to be an arduous task in many states, taking weeks or even months for a former prisoner’s health benefits to kick back in.
But just because Build Back Better is on life support — though not dead yet — that doesn’t mean that the Medicaid Reentry Act has reached the end of the road. To the contrary, this opens up an opportunity for Congress to tackle this problem head-on, either by attaching it to another piece of legislation or by drumming up bipartisan support for another round of criminal justice reform. Either way, Congress should be sure not only to pass the Medicaid Reentry Act but also to expand its ambition and improve health services in prisons more broadly.
The need for the Medicaid Reentry Act as it currently stands is urgent: When people are released from prison, they face a much greater risk of experiencing serious health issues or dying than the general population — especially in their first two weeks back in free society. That’s in part because people who are incarcerated are already more likely to suffer from health problems, ranging from diabetes to mental illness to substance use disorder. But it’s also because upon release from prison, coming across medical care or treatment is not easy. In some cases, people will lose access to potentially life-saving medication altogether.
Ensuring that people will continue to access the care they need, with minimal or no disruption, is the least the government can do to protect people it is responsible for. That’s not only the right thing to do, but it would also lead to better and cost-effective outcomes for both public health and public safety. Increasing access to medical care is shown to reduce recidivism rates for formerly incarcerated people. For example, a Yale researcher found that former prisoners with access to health care were less likely to experience mental health or substance use issues that could otherwise land them back in prison.
But while the Medicaid Reentry Act is a step in the right direction, it’s not nearly enough to address the serious health problems that are associated with a prison sentence. For starters, it would only allow prisoners to gain access to Medicaid benefits in their last 30 days behind bars rather than put an end to the suspension or termination of those benefits upon imprisonment altogether.
American prisons also routinely provide substandard care to their inmates, sometimes in blatant violation of international law, which requires that people in prison be provided with the same medical care and treatment as the general public. And while it’s true that sometimes being sent to prison could be the first time someone is diagnosed with a chronic health condition they may have previously had — a clear sign that the broader health care system also leaves much to be desired — prison overcrowding and a lack of financial investment are causing many prisoners to get inadequate care. That’s why any plan to improve prisoners’ health outcomes, both when they’re behind bars and beyond, should also dedicate the necessary resources to improve prison conditions.
Ultimately, Congress should realize that the government’s responsibility to people in its care does not end once they are released from prison. Acting as though it does makes prison all the more disruptive to someone’s life by actively choosing to make bad outcomes for formerly incarcerated people more likely. That not only fails those individuals, but it fails their broader communities. If public safety is truly about ensuring a safer environment, then improving public health outcomes is a no-brainer — and so too is the Medicaid Reentry Act.
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