Opinion: Expanding Medicaid could cut crime too

Investing in people’s basic life needs can help create safer communities.
John Overmyer/NewsArt

John Overmyer/NewsArt

On January 25, 2023, recently re-elected Georgia Gov. Brian Kemp gave his State of the State address. One focus was to get tough on crime, or in his words, “...we must do something about the revolving door of criminal justice.” His administration has hinted at measures including limiting pretrial release without cash bail and increasing the funding for and number of officers.

Unfortunately, this strong rhetoric was backed by little evidence. To start, holding individuals pre-trial who are bail eligible, simply because they cannot afford to pay, does not provide a public safety benefit. Extensive evidence from multiple cities shows that this practice is expensive, traumatizing and destabilizing. Mr. Kemp also failed to mention that over the past 60 years, the number of officers and overall spending on policing has little correlation to crime rate. Nor that sentence lengthening and enhancements do not contribute to further deterrence of crime, but certainly increase the cost to the state via our ever-increasing elderly state prison population. There was no mention in the address that incarceration does not lower the chance of future criminal activity and may in fact increase it. This missing information would have provided important context for Georgians who expect their tax money to be used effectively.

Mark Spencer, M.D.

Credit: contributed

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Credit: contributed

Thankfully, for Mr. Kemp and the people of Georgia, there is a simple first step: Medicaid expansion. The evidence for Medicaid expansion’s public safety benefits are robust. For instance, expansion was shown to lower overdose rates by 6% and by increasing access to substance use treatment, both violent and financially motivated crimes fell. Even more impressively, from 2014-2016, in expansion counties compared to non-expansion counties, drug arrests were 25-41% lower, violent arrests 19-29% lower, and low level arrests 24-28% lower. A separate paper put the savings from decreased crime at over $13 billion per year from expansion.

These are remarkable numbers that no traditional law enforcement investment can replicate without considerable additional negative consequences mentally, physically, and economically. To truly be tough on crime this is a policy that could be seamlessly implemented without considerable cost as the federal government would pay 90% of expansion costs. Full expansion would help mitigate the pending disaster of hundreds of thousands of people losing their insurance as federal pandemic policy ends and the Medicaid disenrollment process resumes. It would also avoid the bureaucracy of a partial expansion plan that is reliant on ineffective work requirements and would cover far less people at a similar total cost.

With an uninsured rate around 15%, almost twice the U.S. state average, the positive effects of expansion on health and crime would be further enhanced as, typically, higher pre-expansion uninsurance rates have seen more significant effects. It should come as no surprise that Medicaid is such a powerful crime fighting tool as it helps link many low income individuals, who are more likely to be criminalized for their behavior, to substance use treatment, mental health providers, chronic disease management, supportive programming and avoids the consequences of medical debt that can come with being uninsured.

There has long been evidence that investing in people’s environments, lives and basic needs not only improves health outcomes but creates safer communities in ways that policing and incarceration are unable to do.

It is time Georgia’s elected officials follow the evidence and invest in the people of Georgia. Following 2022, a year in which U.S. officers killed more people than has been recorded in recent years, it seems unwise to think further increasing already gargantuan police budgets will result in the safety communities are seeking. With many jurisdictions spending one-third or more of their budgets on policing alone, at considerable opportunity cost to other programs, will safety come at 40% or 50% or 60% of their general funds?

In many cities it seems that police are the only well-funded public institution while health, housing, educational and transportation infrastructure are unable to meet the needs of communities. Additionally, with more people per capita incarcerated in Georgia than in any other country in modern history, at over 900 people per 100,000 compared to, for example, Russia at around 300 or France around 100 per 100,000, to suggest leniency in punishment is at the root of the public safety concerns is patently outrageous. Incredibly, this unparalleled rate does not even include Georgia’s leading rate among all U.S. states for overall correctional control through extensive use of burdensome probation and parole programs.

Put simply, if traditionally “tough on crime” policies led us to collective public safety, we would be the safest state in the safest country on earth. This is decidedly not the case and illuminates the fact that policing is rarely a preventative intervention that keeps harm from occurring.

Mark Spencer, M.D., is an internal medicine resident physician in Atlanta. The author’s views expressed here are his own.