Access to Medicaid coverage may not have a significant effect on reducing crime, undermining an argument for extending the benefits of the social safety net program.
A new study, circulated Monday by the National Bureau for Economic Research, found that the effect of Medicaid enrollment on interactions with the criminal justice system, including charges and conviction rates, may be “more modest than previously believed,” according to the study authors.
“We might have hoped Medicaid would reduce involvement with the criminal justice system — maybe because it helps people get treatment for mental health issues or substance use disorder that could lead to engagement in crime. But, using this unique experiment, that doesn’t seem to be the case,” Sarah Miller, a professor at the University of Michigan and a co-author of the paper, told the Washington Examiner.
Miller, Amy Finkelstein from MIT, and Katherine Baicker from the University of Chicago co-authored the new paper using Medicaid enrollment data from the Oregon Health Insurance Experiment.
In 2008, Oregon implemented a lottery expansion of its Medicaid program for low-income adults, creating natural conditions akin to a randomized controlled trial, the gold standard of social science experiments.
Humanitarian aid has long been an argument for expanding Medicaid benefits, even among Republicans who are skeptical of entitlement programs. But the results of the Oregon study altered the conventional wisdom that Medicaid, and health insurance in general, significantly improves overall health outcomes for enrollees.
Various studies using data from the Oregon experiment found that emergency room visits, outpatient visits, and hospital stays significantly increased with expanded enrollment, as did adherence to prescription medications. But, there were no improvements in rates of cardiovascular disease or high cholesterol.
The experiment, though, did indicate that the expansion helped improve mental health. Miller, Finkelstein, and Baicker predicted that the mental health gains, including significantly lower rates of depression and financial strain, would have had a positive effect on reducing criminal activity, considering the relationship between mental illness and crime.
However, when they correlated Medicaid enrollment data with criminal cases, charges, and convictions over the same study period, the authors found that enrollment made no difference in a person’s likelihood of interacting with the justice system.
“Those randomly assigned to receive Medicaid eligibility are no more or less likely to have a criminal charge or conviction than those who did not get chosen,” said Miller.
There was also no significant difference in whether Medicaid enrollment helped an individual charged with a crime successfully avoid conviction.
Miller highlighted that other more narrowly defined studies have found that expanded Medicaid enrollment does reduce crime rates for particularly risky groups like those recently released from prison.
The results from Miller’s study, however, indicate that these benefits “may not extend to a more general Medicaid population.”
Medicaid reform may be at the top of the Republican agenda this incoming Congress, along with the anticipated fight over whether to extend Obamacare premium tax credits that are set to expire in 2025.
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As of 2022, the federal government covered 71% of the cost of Medicaid, which is administered by state governments, to the tune of $592 billion. Medicaid is the single largest expenditure across all states, representing an average of 26% of each state’s annual spending.
Nearly two-thirds, or 63%, of Medicaid spending comes from states choosing to expand eligibility and benefits beyond federal minimum standards.