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San Francisco’s Sheriff implements Obamacare

CJCJ has previously reported on the potential impact the Affordable Care Act (ACA), otherwise known as “Obamacare”, could have on public safety. A large portion of the population that cycles through our juvenile and criminal justice systems every day are poor or low-income, and face chronic health issues that often go undiagnosed and untreated.

In fact, these health issues are often the underlying causes for criminal behavior: an untreated mental illness or unaddressed trauma that manifests in dangerous behaviors, self-medication for a chronic health condition that results in addiction to illicit substances. On a day-to-day level, people with untreated medical conditions can struggle to find and maintain employment or lead structured social lives.

The ACA presents an opportunity to break that cycle by connecting incarcerated individuals with health care prior to their release. When these individuals reenter society they have immediate access to the treatment and medication they need to manage their illnesses.

On March 13, 2014, San Francisco Sheriff, Ross Mirkarimi told the HuffPost how he intends to implement the ACA to maximize it’s public safety potential. According to Sheriff Mirkarimi, approximately 90% of the people that are leaving incarceration in San Francisco do not have health insurance. The number of people in county jail with chronic mental illnesses and substance abuse issues is skyrocketing, and many of these people are repeat offenders.

In fact, under AB 109 Public Safety Realignment, county sheriffs are being asked to step up their rehabilitative programming, as they are now responsible for a more sophisticated population that are spending longer periods of time in jail. For Sheriff Mirkarimi, the ACA presents a long overdue opportunity to unite public safety and public health to confront these trends: 

“Without a state mechanism in place to deal with a psychiatric or mentally ill population then by default… our jail systems are in danger of becoming substitutes for mental health hospitals, and as Sheriff I reject that. We cannot be criminalizing for substance abuse and drug addiction, or for mental health illnesses.” 

According to the Sheriff, under the ACA people with income less than $15,857 would be eligible for Medi-Cal, which would cover mental health and addiction issues. San Francisco already had it’s own version of universal health care for indigent people, providing a real approximation of costs under the ACA. Sheriff Mirkarimi believes it will result in savings for the resident taxpayers and reduced recidivism. Something he describes as "a win-win":

“We do a great job in jail, thanks to our public health department of triaging and managing people with chronic health conditions. But my goal as sheriff is not to just pass the baton... it is to make sure that people do not return.”

The ACA could be the first step in creating a continuum of health care that will create better public safety outcomes in San Francisco. The vision that Sheriff Mirkarimi presents, of synergy across criminal justice and public health departments, is fundamental to achieving more positive health and public safety outcomes for all Californians.

Keywords: Affordable Care Act, jails, San Francisco, Selena Teji

Posted in Blog, Model Local Practices, Correctional Institutions

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