Bolts magazine follows up on studies showing a link between health insurance and crime rates (that is, the less people are insured, the higher crime rates tend to go) by focusing specifically on Medicaid, the U.S. government plan intended to cover low-income recipients’ medical costs. They found that states which make it harder to qualify for Medicaid saw a jump in crime – and states that sink a lot of money into punishing criminals would actually save a lot by funding healthcare instead:
To study these relationships, [George Mason University researcher Connie] Maclean and her coauthors examined crime rates in Tennessee before and after that state disenrolled some 200,000 people from Medicaid, with little warning, in 2005. That was and still remains one of the most sweeping state-level Medicaid drop-offs in U.S. history.
By 2007, the study finds, the crime rate in the median Tennessee county had increased by almost 17 percent, with large increases observed in both violent and non-violent crime; the study attributes this to the disenrollment through a series of causal analyses. “Losing Medicaid induced changes in economic standing, housing stability, healthcare use, and health, all of which are documented to be determinants of crime,” the authors write.
It stands to reason, Maclean said, that crimes inspired by desperation or behavioral health crises—or both—became more common in Tennessee post-2005, as poverty increased and people became more likely to delay needed health care. This was especially devastating for people who might have benefitted from mental health care or treatment for substance abuse disorder, the study found.
These patterns now risk repeating themselves at a large scale. Just last year, every state in the U.S. experienced a major contraction in Medicaid coverage, as the federal government ended an emergency pandemic policy that had kept millions enrolled in the program.
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There’s plenty of existing research on how people become less likely to commit crimes after gaining health coverage. Your study notes there’s been much less research into what happens when people lose coverage. Why did you find that important to examine?Over time, generally, Medicaid policy has led to expansion in coverage. But we’re now starting to see increasingly more talk and action about policy that could curtail it.
Some of these losses may come as more of a surprise. (Editor’s note: People who lose Medicaid coverage due to a change in rules, or a lapse in documentation, may not find out in a timely manner or with advance warning.) If you’re gaining Medicaid, it may be that you’ve taken steps—you’ve applied for Medicaid and you’ve shown documentation, so it’s not much of a surprise. If you just suddenly lose Medicaid, that can be very destructive in and of itself, and also for the inability to plan for what you’re going to do next.
Your study found that crime increased generally in Tennessee among those who’d lost health coverage, and that the increase in nonviolent crime was particularly clear. What does that tell us?
I think our findings pointed toward a financial resources story. That is, we found stronger, more stable effects for non-violent crime, which tend to be property crimes. The property crimes we looked at are burglary, theft, motor vehicle theft, and arson. The violent crimes we looked at were murder, manslaughter, rape, sexual assault, robbery, and assault. When we broke these crimes out, we see that our findings for non-violent crime were really driven by theft.
That, to me, suggested that some of these crimes we see might be financially motivated, which might be due to the loss of resources that one experiences when Medicaid is removed, or it could be increased need to finance medical bills.
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Today, many politicians who tend to oppose expanding social services, including government-covered health benefits, also tend to support “tough on crime” policies. Why do health access and public safety so often appear in conflict?
It does seem to me that there’s a strong correlation between policymakers and politicians being tough on crime while also taking a conservative view of the role of government in the provision of health insurance. People can certainly have different views about that role of government, but I sometimes suspect there is less [of] an understanding of the potential linkages between the two.
When you give people access to Medicaid, they generally have better financial outcomes.
You see increases in poverty when you curtail Medicaid, as was done in Tennessee. The idea is that health insurance, in addition to providing access to care, also protects people against the risk and cost of unexpected health care expenditures. You see increases in evictions as well. You can think of a whole range of outcomes that could be improved with the provision of health insurance. It seems like there are other means through which we could reduce reliance on the criminal justice system.
Just to say, alright, let’s hire some new police officers or let’s buy some new infrastructure for the police to use—it’s there, it can be seen, you can show your constituents what you’ve done. There’s something about being able to show your constituents that you did something.
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You can read more of the public health study here, at the National Bureau of Economics (pdf).