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The striking new evidence that expanding health coverage reduces crime

Dylan Scott covers health care for Vox. 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.

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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

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