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In prison you get health care. When you're released ...

An immigrant receives dental care at the Adelanto Detention Facility on November 15, 2013 in Adelanto, Calif.

People in prison are sick. A recent report found the nation spends more than $6.5 billion every year on healthcare services for the men and women who are incarcerated. But right now, much of that care stops as prisoners are released.

And many prison officials believe that’s part of the reason why so many former inmates keep coming back.

The Affordable Care Act could interrupt this cycle beginning in January as several hundred thousand former inmates become eligible for healthcare.

Miguel Rodriguez has been in and out of prison for more than 30 years, usually for selling heroin. And after every release, it’s been the same story.

“Go to the corner, to go sell and get high,” he says. And then land back in prison all over again.

When he was released for the last time a couple years ago, Rodriquez, now 53, was suffering from Hepatitis C, congestive heart failure and asthma.

“I couldn’t walk from here to that window," he says. "It would take me half hour to walk one block. That’s how my health really was.”

Rodriguez has been in and out of the hospital six times, the emergency room 10 times. He’s had a pacemaker and bypass surgery. And because he can’t pay, hospitals have eaten those costs, which get passed on to the rest of us.

Dr. Ingrid Binswanger of the University of Colorado says the Affordable Care Act might catch people like Rodriguez before their health hits rock bottom, and their healthcare costs skyrocket. 

“We could potentially treat those conditions before people need to be hospitalized or go to the emergency room,” she says. 

Under the new health law, nearly half of all inmates who leave prison next year - some 300,000 - will be eligible for health insurance, primarily through Medicaid.

Historically, many states have barred low-income adults without children from signing up. Under the ACA that restriction now goes away.

“There has been nothing in my career that has been this exciting as this moment,” says Dr. Emily Wang,  a primary care physician who teaches at Yale Medical School and treats former inmates.

Wang has seen that simple access to care – particularly for substance abuse or mental health – can help ex-cons find their footing. And save money in part because this patient population is so expensive to treat.

“Individuals that are released from prison, they are 12 times more likely to die even in the first two weeks following release," she says. "They are more likely to be hospitalized, they are more likely to go to the emergency department.”

Wang says about 85 percent of prisoners have some kind of health problem.

This helps explain why a large chunk of prison budgets goes towards healthcare, running into the billions every year. New York state spends about $74 million dollars annually just on medications.

“What the public generally doesn’t know is that we are essentially cycling people with mental illness, substance abuse problems through our jails and prisons and back out again,” says Jack Beck with the Correctional Association of New York, which monitors prison conditions.

Behind bars, Beck explains, inmates get treatment; they get meds, their chronic conditions in check. When they get out, all that goes away.

And Dr. Wang says that’s when taxpayers get slammed.

“Because you are paying for the care now," she says. "You’re paying for the cost of their care, when they are using the emergency department, when they are hospitalized for conditions that are preventable.” 

Wang says the next step is to get insurance to former inmates as soon as they hit the streets.

That may not be as easy as it sounds. 

“Nobody is really responsible, no agency, for what happens to ex-offenders when they leave,” says Donna Strugar-Fritsch, a prison consultant with Health Management Associates, who works with local governments.

Strugar-Fritsch says many states are still putting systems in place to simply make sure inmates walk out of prison with Medicaid cards. And even for those who are insured, there is a shortage of treatment programs for substance abuse and mental illness.

But in states expanding Medicaid under the ACA, there’s momentum to deal with these knotty questions. Bottom line: it costs a lot more to keep someone in prison than it does to provide them with the kind of healthcare and services that might keep them out.

Miguel Rodriguez, who says he has stopped taking heroin, goes to an out-patient substance abuse program several times a week. And soon he will have Medicaid.

“Now I can make my doctor’s appointments, I can get my medications,” he says.

But insurance is a tool, it’s no guarantee. For his coverage to work, Rodriguez must do something he’s never been able to do, take care of his health.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

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