Gary Herbert, Utah’s Republican governor, has a health-care problem. Under the Affordable Care Act, states are eligible for federal money to pay for expanding access to Medicaid, the health insurance program for the poor. Herbert’s spent more than a year pushing Utah’s GOP-controlled legislature to accept the cash, but he’s run into resistance from conservatives opposed to Obamacare. Lately he’s gotten help making his case from an interest group not known for its liberal inclinations: cops.
Police chiefs and sheriffs who run local jails in states that haven’t expanded Medicaid are coming out in favor of Obamacare on the grounds that it could help drug addicts and people with mental illness get help before they commit crimes. Thirty states have increased access to Medicaid. Broadening eligibility could extend coverage to about 3.7 million people in 20 states, according to estimates from the Kaiser Family Foundation. That includes 30,000 in Utah, about 1 percent of the state’s population.
Jim Winder, the elected sheriff of Salt Lake County, says 15 percent to 18 percent of the 40,000 people booked each year into the county jail—Utah’s largest—are severely mentally ill, about the same as the national rate. He spends $3 million to $5 million a year on psychotropic medication, out of a budget just shy of $90 million. Even if inmates have private insurance, the jail picks up the tab for them while they’re locked up. It often takes days or weeks to stabilize them, and many are arrested again soon after release. “I’ve got people who we’re booking 150 times a year,” says Winder, a Democrat serving his third term. “If people think for a moment we’re not paying for this, they are sadly mistaken.”
In March, Utah’s legislature passed a justice reform bill lowering the penalties for drug possession. The law contains provisions for putting addicts in treatment rather than in jail. Law enforcement leaders say that’s a step in the right direction but worry that without additional funding—whether from federal Obamacare funds or some other source—there won’t be enough space in rehab programs to accommodate the increased demand. “At the end of the day we will just have more crimes committed by people who are trying to fund their drug habits,” says Chief Tom Ross of the Bountiful (Utah) police department, who hasn’t taken a position on Medicaid expansion. He’s president of the Utah Chiefs of Police Association, which has also stayed neutral on the Medicaid issue.
More than 350,000 people with serious mental illness are incarcerated, or about 16 percent of America’s 2.1 million inmates, according to research by the Treatment Advocacy Center. The group estimates that more than half of those shot and killed by police each year are mentally ill.
Gabriel Morgan, the sheriff of Newport News, Va., says improving mental health care became a priority for him after a deputy was assaulted by an unstable inmate in 2007. The deputy lost an eye and wound up with five titanium plates in his face. The department frequently responds to mental health crises, including some people who aren’t accused of crimes. In a recent week, Morgan says, officers took custody of 14 people who had to be involuntarily committed, in a city of 188,000. Morgan supported Virginia Democratic Governor Terry McAuliffe’s plan to expand Medicaid, which Republicans scuttled earlier this year. “We are arresting too many people who would never have committed a crime if they had gotten help,” says Morgan. “The question is, do we go upstream? Or do we go downstream and wait for the bodies to come down?”
Salt Lake County Sheriff Winder says lawmakers he talks to in Utah appreciate the adverse social effects of making it difficult for the poor and indigent to get medical care, but that doesn’t stop partisanship from getting in the way. “People’s eyes glaze over, and they just say one word: Obamacare,” says Winder. “After that, you may as well be talking to a pig about Christmas. It’s not going anywhere.”
The bottom line: Some cops support expanding Medicaid to cut crime by increasing access to mental health care and addiction treatment.