San Francisco Aims to Sign Up Inmates for Health Coverage

Jan. 29--Affordable health care is coming to the San Francisco jail system -- and Sheriff Ross Mirkarimi thinks it will save taxpayers millions of dollars and potentially reduce the number of people behind bars in years to come.

The federal Affordable Care Act may be controversial elsewhere, but city officials have embraced it wholeheartedly, and the sheriff's move will probably open up free or low-cost medical care to most of the 31,000 people booked into the city's jails each year once they are released.

On Tuesday, Mirkarimi introduced legislation before the Board of Supervisors making his office responsible for assisting County Jail inmates with submitting applications for affordable health coverage, a legally required step before the signups inside the jail system can begin. Inmates won't be eligible for coverage under the Affordable Care Act until they leave jail, but the sheriff's move ensures they will have health care once they are released.

Mirkarimi said an estimated 90 percent of men and women in county jails around the nation do not have health insurance, and the same number are expected to qualify for subsidized health care coverage under President Obama's signature health care legislation. Many may qualify for Medi-Cal, which is offered to anyone making less than $15,857 a year and covers mental health and drug treatment deemed medically necessary.

The move could save the city millions of dollars in emergency room visits and other health care costs: The Sheriff's Department estimates that San Francisco will save about $2,500 per year on each inmate it enrolls.

And it's not just primary care. Jail inmates are more likely to have chronic conditions such as hypertension, diabetes, asthma and arthritis, not to mention substance abuse and mental health problems.

"The San Francisco Sheriff's Department will be one of the first county jail systems in the nation that's officially designated to enroll inmates into the Affordable Care Act," Mirkarimi said in a written statement. "The vast majority of jail detainees have no private or public health insurance or the financial resources for medical care upon release."

In addition to medical savings, Mirkarimi said the program has the potential to lower recidivism by connecting former inmates with substance abuse and mental health treatments. His office has projected a 20 percent reduction in future arrests for inmates who are enrolled in health care programs before they leave jail.

"Enhancing access to integrated health care for the uninsured is not only a wise public health move, but it's also wise public safety strategy -- there is nexus between repeat incarceration and poor chronic health, especially people suffering with mental illness or substance addiction," he said.

Jeanne Woodford, a former San Quentin State Prison warden and a senior fellow at UC Berkeley's Chief Justice Earl Warren Institute on Law and Social Policy, agreed, saying health care for former inmates should be viewed as a public safety issue.

"I think one only has to look at when AIDS became an issue. There were people leaving prison HIV-positive or with full-blown AIDS and there was no treatment in the community, so they would violate their parole on purpose to get medical care," she said, adding that recidivism among those populations declined once cities started offering more treatment.

"Having access to medical care, mental health care and drug treatment ... is so important for this population. I think this is going to improve public safety," she said.

Inmates in San Francisco County Jail already receive extensive mental health, substance abuse and medical treatment, the sheriff noted. But if those services are cut off when someone is released from jail, "we will not see a significant, long-term impact on individual and public health," he said.

Marisa Lagos is a San Francisco Chronicle staff writer. E-mail: mlagos@sfchronicle.com Twitter: @mlagos

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