Investments in Public Health Result in Benefits to Public Safety

Brian Skinner Government & Policy, Medicaid



By Brian Skinner, Esq.

This summer there have been increased calls for diverting funds from public safety and placing more of an emphasis on social programs. In a recent interview, vice-presidential candidate and United States Senator Kamala Harris summarized these efforts — “We need to re-imagine how we, as a society, are going to achieve public safety… We should be putting resources into our public health systems. We should be looking at our budgets and asking, ‘Are we getting the best return on investment as taxpayers?’”

A recent paper from researchers at University of Texas at Austin provides evidence that investments in public health systems can indeed improve public safety and can do so in a cost-effective manner. In this case, the investment in public health is the expansion of Medicaid, the largest means- tested program in the United States. The study demonstrates how expanding Medicaid coverage for low-income children results in significant savings to direct incarceration costs.

In the late 1980s and early 1990s, Congress sought to increase health insurance coverage among disadvantaged children. The study looked at the coverage expansion included in the Omnibus Budget Reconciliation Act of 1990 (“OBRA90”) which greatly expanded Medicaid eligibility nationwide among children in families below the Federal Poverty Level.  The study found that children born just after the cutoff are 5 percent less likely to be incarcerated by age 28, driven primarily by a decrease in incarcerations connected to financially motivated offenses. Children who experienced almost no gain in Medicaid coverage as a result of the policy, demonstrate no such decline. Their conclusion — reduced incarceration in adulthood substantially offsets the initial costs of expanding eligibility.

Researches calculated that each dollar spent on the provision of Medicaid returned 40 cents in savings on direct incarceration costs alone (i.e., expenses associated with confining an inmate). This estimate rises to 66 cents on the dollar if the economic losses (e.g., decreased earnings) caused by imprisonment are incorporated into the calculation. These benefits do not take into account the underlying decrease in crimes that lead to incarceration, which would imply a substantially greater return. Overall, the study found that the OBRA90 expansion is highly cost-effective, even without considering any direct socioeconomic and health benefits provided by youth Medicaid eligibility.

The study was also able to outline how an increase in public health spending results in changes in behavior that ultimately lead to decreased adult imprisonment. First, the observed decline in incarceration is driven primarily by a decrease in incarcerations connected to financially motivated crimes. Drug trafficking, selling, manufacturing, and distribution fall sharply at the cutoff, while drug possession is unchanged. They also note that these reductions are consistent with a large literature showing that financially motivated criminal activity is sensitive to changes in economic conditions

Second, OBRA90 expansion dramatically increased the detection and treatment of attention deficit and hyperactivity disorder in children, a disorder that has been connected to a host of problems, including increased rates of incarceration.

This study is also important because it offers additional evidence of the impact of social safety net programs on incarceration, including the effect increased insurance coverage has on incarceration rates. But more importantly, the paper adds to the large and growing literature documenting the long- term impacts of access to Medicaid in childhood. Not only the positive impact on the overall health of children who have access to health insurance but increased future earnings and less reliance on government assistance.

This study has implication for policymakers at both the state and federal levels. It adds to the growing evidence demonstrating that investments in social programs, particularly public health systems, can yield public safety benefits. Smart, effective policies that focus on public health can lead to not only a decrease in racial disparities, both in incarceration and public health, but improvements in public safety, including a reduction in incarceration expenses. Outcomes that taxpayers will appreciate.

Brian is the former counsel to the West Virginia House of Delegates Judiciary Committee and counsel to the West Virginia Senate Minority Caucus. He was also general counsel to the West Virginia State Health Officer and Commissioner for the Bureau for Public Health. He has almost two-decades of experience as a strategic advisor and chief legal counsel to both executive and legislative branch public officials.