The Effect of Public Health Insurance on Criminal Recidivism

The jails and prisons in the US correctional system are called "the new asylums" due to the high prevalence of mental health disorders and addiction among inmates and prisoners. Many of the offenders reenter the community without receiving specialized treatment during incarceration and reoffend within the first year after release. The Affordable Care Act (ACA) included mental health and substance abuse services as essential health benefits for the poor, which can potentially increase access to treatment and affect recidivism. We exploit the plausibly exogenous variation in the expansion decision and timing of states to estimate the effect of the ACA's Medicaid expansion on the probability of prison reentry by various offense types. Using administrative data on prison admission and release records from 2008 to 2016, we find that the Medicaid expansions decrease the probability of prison reentry for both violent and property crimes. The effects are salient for crimes that are triggered by mental illnesses and/or substance abuse. These findings are robust to the inclusion of state time-varying effects and changes in the sample composition.