Mercedes Smith walked out of Bedford Hills Correctional Facility after 20 years, hoping to become a productive member of society.
Shortly after she was released in June 2010, Smith found a part-time job. She was thrilled — until she found out that working for $13 an hour meant her newly acquired Medicaid insurance would be terminated.
Medicaid, a federally run health program, is designed to provide coverage for low-income and disabled individuals. But in New York, where Smith lives, single adults without dependents who earn more than $8,994 a year don’t qualify. In other states, the qualifying income level is even lower. Adults without children in nearly half of states don’t qualify at all.
It’s a population known as the working poor: They earn too much to qualify for Medicaid but not nearly enough to pay for private health insurance.
Smith chose to keep her job and prayed she wouldn’t fall ill. She worries constantly about her atopic dermatitis, a skin condition that can be controlled only with a prescription medication cream she can’t afford.
“I have to pick and choose when I go to the doctor,” Smith said. “When I get really, really sick, I have to go to the emergency room.”
Experts hope Obamacare will change that. They estimate that 30% to 50% of released U.S. prison inmates will be newly eligible for insurance under the Medicaid expansion that covers people who earn up to 133% of the federal poverty level: about $15,800 a year for a single person.
Twenty-five states and the District of Columbia have chosen to expand their Medicaid programs. And all states must now cover behavioral health treatments at the same rate as they cover physical ailments. So any inmate who qualifies for Medicaid or Medicare, and those who can afford health insurance, will be able to get help for substance abuse and mental health problems.
That care could be the “stay out of jail free” card former inmates need, experts say. Whether the infrastructure is in place to support those dreams is another question.
The Health-Care Survivor’s Comment
Whatever one might think of the UK’s National Health Service, with it’s laudable goals, and it’s lamentable shortcomings, this story should remind us what a disaster it would be for personal and public health, if access depended upon income.