I began my public health career on a Yale postdoc. One of my formative experiences there was to accompany colleagues on the Community Health Care Van, a needle exchange-based mobile clinic for street drug users.
Tagging along with the staff, I helped some patients complete basic paperwork. A weathered middle-aged guy stepped on. When I asked what brought him there, he pulled back his shirt to reveal a chalky-white oozing crater in his shoulder. That festering infection was my rude introduction to the life realities of injection drug users.
Most of these women and men suffered greatly with addiction and a variety of complex illnesses. Most were uninsured, yet still consumed enormous health system resources as they cycled through correctional facilities, became emergency department frequent-fliers, and required heavy use of other safety-net services.
The CHCV reduced patients’ emergency department use by about twenty percent. We could have done more if we could have provided reliable primary care, appropriate drug treatment, and other services requiring insurance coverage.
This won’t matter politically, but the Affordable Care Act will quietly improve public health by expanding coverage for hundreds of thousands of ex-prisoners and others under the control of the criminal justice system. Most of these men and women are on parole or probation. A nice Health Affairs paper by Alison Evans Cuellar and Jehanzeb Cheema runs the numbers. Roughly half of the 700,000 people released every year from correctional institutions will gain coverage or improved care under health reform.
More here, in my latest column for healthinsurance.org.