After an extended debate, much of which was uninformed or intentionally mis-informed by critics, the Affordable Care Act was upheld by the U.S. Supreme Court.
As noted, this is an important moment in the U.S. history, a filling in of an area of citizen welfare that other advanced industrial nations (and others that aren't) figured out long ago. It is absolutely amazing and grotesque that Republicans in Congress are so bitterly opposed to what their own citizens want and need and now salivate at the thought of being able to repeal all or most of it.
Of course this law as implemented has had direct implications for the criminal justice system, for persons under arrest and in the care and keeping of the criminal justice system. Locally, health professionals noted its importance.
The new law has led to dramatic and long-term significant changes in the shape of corrections in California, as noted in a 2016 report with general update, including graphical displays, "California's Historic Corrections Reforms."
As the report notes, over time we have seen substantial implementation of the law in California. Beyond this, it's important to note that the field of criminal justice is highly sensitive to changes in the health care system--adequate medical care is one of the best crime prevention policies around. As the long history of the criminal justice system attests, when people lack any or adequate health care, their problems multiply and this can easily put them at risk of falling into the hands of the criminal justice system--leaving criminal justice personnel with the task of providing a short-term solution to a community problem. This is most obvious in the case of substance abuse treatment and mental illness but also in a great many other situations.
An even more recent 2016 report from PPI at this link, entitled "Expanding Health Coverage in California: County Jails as Enrollment Sites," has done an excellent job of estimating both the utility of and need for ACA and other coverage of Californians. Reviewing prior research, they have demonstrated the incredible potential benefits of health care coverage for management of the crime problem in California, shown how many gains have been made in providing coverage, and further identified jail populations as potential places in which to enroll populations in great need of services that directly relate to their criminal justice system involvement. They note:
California has made substantial progress in increasing insurance coverage under the ACA. In 2014, the number of uninsured residents declined by 2 million, nearly 5 percentage points. However, millions of residents remain uninsured, and state and local agencies continue to try to connect those who are eligible to available coverage options. We find that uninsured Californians in 2014 are disproportionately young and male. Among young men, we find that those with low education levels, low incomes, and less attachment to employment are especially likely to be uninsured.
California's jail system may offer important opportunities to reach a share of the uninsured--particularly those who are harder to reach through traditional enrollment mechanisms. In addition to helping the state meet its health insurance coverage goals, enrollment assistance efforts offer the potential to leverage federal and state Medi-Cal resources to improve access to needed physical and behavioral health resources for the reentry population. Existing research suggests that interventions that improve access to health-related services could go a long way toward reducing recidivism, and the associated cost savings have the potential both to reduce the correctional cost burden on counties and to free up resources for additional reentry programming. As counties initiate and expand enrollment assistance efforts, the diversity in their approaches can help us track key differences among models and identify best practices.
For now this is a time to rejoice and celebrate a new and long-needed chapter in the uneven progress of improved quality of life for Americans. Focusing physical and other health assistance on reentering jail populations using federal and state resources has enormous promise for short and long health improvements and cost savings for Californians. Working with local jails is extremely challenging due to their rapid population turnover but the strategies outlined in this report, including the one centering on sentenced inmates, make very good sense.