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Repealing and Replacing Health Care Law Would Affect Our Criminal Justice System

Changing health care law does not occur in a silo. There will be ripple effects. 

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The U.S. has been on a punishment binge for the past 50 years. We have the largest prison system and the highest rate of incarceration in the world. The invoice for all of this is about $1 trillion per year for our criminal justice system and the collateral social and economic costs that follow it.

The recent recession that devastated the economy and drastically diminished tax revenue stimulated states to take a hard look at how they spend money. A common target of spending cuts has been incarceration, leading to slight reductions in the overall prison population across the country.

Reducing the prison population may be wise fiscal reform. It is, however, not criminal justice reform.

Many of the problems with the criminal justice system are a result of one glaring fact – the recidivism or reoffending rate is more than 65 percent. This leads to extraordinary court dockets and excessive and unmanageable caseloads for prosecutors, public defenders, and probation and parole officers. It also causes overcrowded jails and prisons.

Our failure to reduce recidivism has resulted in a nearly perfect revolving door. At the same time, we have unnecessarily and avoidably exposed all of us to the risk of criminal victimization and wasted enormous amounts of money.

Where do we go from here?

Comprehensive criminal justice reform should be based on understanding what drives recidivism and in turn, determining how to effectively and cost-efficiently reduce it. Here is what we know.

Nearly 50 percent of people in the criminal justice system have a mental illness. The vast majority of them have a substance use disorder, meaning addiction, dependence or abuse. Sixty percent of prison inmates have had at least one traumatic brain injury, often resulting in cognitive impairments such as problems with impulse control, decision making, planning, attention, goal-directed action, self-monitoring and complex cognition. In addition, many criminal offenders have educational deficits and employment and housing problems, among others.

These are not excuses or apologies for crime. They are the realities. Another reality is that offenders with a mental illness or substance use disorder have an 80 percent recidivism rate. We cannot punish mental illness out of someone, and there is nothing about prison or jail that fixes addiction or cognitive dysfunction.

The good news is that there is overwhelming clinical evidence that many of the disorders, deficits and impairments that offenders have can be treated, mitigated and managed, substantially reducing recidivism and saving tremendous amounts of money.

The state of our criminal justice system is, in part, the result of the failure of public health. The unfortunate fact is that the criminal justice system has become the dumping ground for many disordered offenders, the vast majority of whom do not have the resources to obtain treatment. As a result of offender indigence and inadequate public health funding, many end up in the criminal justice system simply because there is nowhere else for them to go. There is no way to think of that as an acceptable or sustainable outcome.

Despite the Republican opposition to it, the Affordable Care Act, or Obamacare, has gone a long way in expanding both public and private funding for treatment for mental illness, substance abuse and neurocognitive disorders. That has extremely important outcomes for public safety. All of that is at risk of going away.

Today, Medicaid provides the majority of mental health treatment in this country. Medicaid is also a substantial funder of all substance abuse treatment.

One of the key provisions of the House version of repeal and replace is a substantial rollback of Medicaid expansion. The Senate version includes massive cuts to Medicaid.

Changing health care law does not occur in a silo. There are realities of repeal and replace that go well beyond the political advantages many who support such changes may enjoy. All members of Congress represent states that will experience the important negative consequences for crime, recidivism, victimization and the cost of criminal justice. When have we had enough? When do we demand an end to the revolving door and massive fiscal waste?

William R. Kelly is a professor of sociology at The University of Texas at Austin. His most recent books on criminal justice reform are “The Future of Crime and Punishment: Smart Policies for Reducing Crime and Saving Money” (Rowman and Littlefield, May 2016) and “From Retribution to Public Safety: Disruptive Innovation of American Criminal Justice” (Rowman and Littlefield, June 2017).

A version of this op-ed appeared in the Abilene Reporter News, McAllen Monitor, and the Austin American Statesman.

To view more op-eds from Texas Perspectives, click here.

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Texas Perspectives is a wire-style service produced by The University of Texas at Austin that is intended to provide media outlets with meaningful and thoughtful opinion columns (op-eds) on a variety of topics and current events. Authors are faculty members and staffers at UT Austin who work with University Communications to craft columns that adhere to journalistic best practices and Associated Press style guidelines. The University of Texas at Austin offers these opinion articles for publication at no charge. Columns appearing on the service and this webpage represent the views of the authors, not of The University of Texas at Austin.

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