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The striking new evidence that expanding health coverage reduces crime
Dylan Scott covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017.
It seems like we spend all of our time debating whether health insurance actually improves people’s health and, to a lesser extent, how much financial security it provides them.
Those things are important! But health coverage also changes our society in ways that aren’t so obvious.
For instance: Health insurance seems to help fight crime.
This concept has been floating out there for a while: Friend of VoxCare Adrianna McIntyre wrote about “Obamacare’s secret crime-fighting potential” back in 2014.
But we have some new data that suggests getting more people health insurance actually causes a decrease in crime.
Jacob Vogler, a PhD economics student at the University of Illinois, looked at crime rates before and after Obamacare’s Medicaid expansion, comparing states that didn’t expand and states that did. He also whittled down to a more granular level, looking at the crime rates in counties in Medicaid expansion states that saw the biggest increases in coverage.
This is what he found:
- Incidents of reported violent crimes decreased 5 percent, per 100,000 people, in Medicaid expansion states compared to non-expansion states.
- Incidents of property crime decreased by 3 percent.
- Homicide, aggravated assault, robbery, and vehicle theft all saw statistically significant declines.
- At the county level, counties that saw bigger coverage gains saw bigger crime reductions: A 1 percent gain in coverage correlated to a 0.7 percent drop in violent crime.
- Vogler used some back-of-the-napkin math to estimate that this decrease in crime led to $400 million in savings to society, based on existing estimates of how much different crimes “cost.”
“The analysis reveals economically meaningful and robust evidence that expanding health insurance eligibility reduces rates of reported crime,”he writes.
The working paper doesn’t delve into why crime seems to go down when health coverage goes up, but it does attempt to show a direct cause and effect.
And we do know that people who commit crimes tend to either be outright uninsured or have barriers to insurance. Vogler cites previous studies that found 90 percent of people entering local jails were uninsured before 2014. Other research has found that about 60 percent of people arrested earn an income that would make them eligible for Medicaid expansion if their state elected to expand the program.
We also have some evidence that direct interventions to expand coverage help reduce crime. McIntyre flagged a program in Michigan that started in 2007, which connected people recently released from prison with a medical home.
The recidivism rate fell by more than half, from 46 percent to 21.6 percent, among that population. McIntyre reported that the staff members who helped implement the program thought that increased access to health care had made a substantial contribution.
These findings, and Vogler’s research, remind us to keep an expansive view of what health coverage can help achieve.
Chart of the Day
Kaiser Family Foundation
“Obamacare is Obama’s fault.” That’s what President Trump told Forbes. We have reviewed ad nauseam the ways the Trump administration has undercut the health care law, but the president still seems to believe he is immune from any political backlash if the law struggles as a result.
This August poll from the Kaiser Family Foundation suggests he’s wrong about that. Most Americans, even a substantial minority of Republicans, believe that Trump and Republicans in Congress are responsible for Obamacare now.
There is a bit of a “you break it, you buy it” deal with the public when it comes to health care. Or maybe it’s even simpler than that: You’re in charge, you’re responsible. It doesn’t appear Americans have much tolerance for blaming one’s predecessors for today’s problems.
Kliff’s Notes
With research help from Caitlin Davis
Today’s top news
- “Washington state sues over new Trump birth-control rules“: “State Attorney General Bob Ferguson, who successfully sued to block Trump’s initial travel ban early this year, announced his latest lawsuit on Monday, three days after the new rules were issued. Other Democratic-leaning states, including Massachusetts and California, sued on Friday, as did the American Civil Liberties Union.” —Gene Johnson, Associated Press
- “Trump says health care executive order will allow coverage to be sold across state lines”: “Trump is planning to sign the directive on Thursday, a source briefed on the plans said, in a move that would follow through on his repeated calls to open up the sale of health insurance across state lines.” —Adam Cancryn and Louis Nelson, Politico
- “White House: Obamacare order caused by frustration over congressional inaction”: “Trump is expected to release an executive order this week intended to help insurers sell plans across state lines. White House press secretary Sarah Sanders said the order is in response to inaction from Congress.” —Robert King, Washington Examiner
Analysis and longer reads
- “AMA’s doctor panel still operates behind closed doors”: “Medicare said this summer it will accept nearly every payment recommendation from the committee going forward — which means tens of billions of taxpayer dollars for physician services still hinge on meetings that can’t be discussed publicly.” —Bob Herman, Axios
- “Trump’s Cuts to Health Law Enrollment Efforts Are Hitting Hard”: “With the annual open enrollment weeks away, the federal spending cuts have begun to bite, and navigators around the country are racing to revise their plans to make do with less money. “ —Robert Pear, New York Times
- “Here’s how a loophole in a transparency law can distort medical practices”: “A company is not required to report payments if it does not yet market a medicine approved by the Food and Drug Administration. This means that a slew of small companies can fly under the radar as they line up allies in the medical community on their way to the marketplace.” —Ed Silverman, STAT
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