Brown University Professor on Medicaid and Prisons

In late July, our group had the opportunity to discuss the effects of hyper-incarceration on minority communities with Bradley Brockmann, JD, MDiv, who is a civil rights attorney and an Assistant Professor in the Department of Health Services, Policy & Practice in the Brown University School of Public Health. Brockmann collaborates with justice system stakeholders to identify and support projects that respond to the challenging issues that arise at the intersection of incarceration, recidivism, and public health locally and nationally. His current research with the Maine Department of Corrections is to document and assess the Department's development and implementation of policies and practices intended to shift the operating culture of the state's maximum security prison from one of punishment to one of wellness.

On Medicaid: Communities of color are the most disadvantaged when it comes to medical care; in addition to usually having low resources and access to healthcare, it can be difficult for them to receive treatment through Medicaid because it is not universal. Prior to 2014, Medicaid was generally not designed to provide healthcare to low-income individuals. In fact, its original purpose was to protect children living in unstable homes, as well as to provide for the disabled. However, after the passage of the Affordable Care Act, Medicaid was made available to all low-income individuals. Despite this historical step, Medicaid failed to serve as a safety net program and as preventive care because many state programs, including those made to treat mental illnesses, were vastly underfunded. Consequently, these programs were rendered ineffective. Low-income patients had no choice but to go to hospital Emergency Rooms for their minor issues, which was oftentimes very expensive because they usually received costly treatment that they did not need.

On Medical Care in Prison: Despite the racial disparities that are present in the nation's medical care system, all incarcerated citizens in prison usually receive the same low-level care for their health issues. In fact, medical treatment is so bad in prison that it can have a "leveling effect", where whites, who would usually receive better care than Black and Brown people in society, now suffer from the same poor treatment. Because of this poor treatment, prisoners' health conditions usually worsen while they are serving their sentence; those who have mental illness are at the greatest risk of health deterioration because they do not receive the specialized care they need. Although medical treatment in prison is inadequate for all incarcerated people, its effects are especially drastic for people of color because they make up the greatest percentage of the prison population.

On Recidivism: In order to prepare released cities from prison for the path towards rehabilitation, states should ensure to connect them to care in the community. This is an essential step because it would address the untreated health issues of ex-prisoners; according to Professor Brockmann, approximately 65 percent of the individuals who are incarcerated have a diagnosable mental health problem, including those who use and/or distribute drugs. The community's involvement in these citizens' lives, which can be funded by diverting money from prisons to community resources. Additionally, communities would need to expand their number of mental health clinics and substance abuse centers in order to be able to treat more people. Though these solutions may seem impractical, they have been successfully implemented in some areas of the country, lowering rates of incarceration by treating drug users as medical patients rather than as criminals. For example, the goals highlighted above are occurring in Rhode Island, where they began the first program for opioid treatment in the nation. By medically treating opioid addiction, which over twenty-five percent of incarcerated citizens suffer from, Rhode Island is providing mental, developmental, and preventive care. To decrease the amount of low-income citizens taking costly visits to emergency departments, more states should implement effective, drug-addiction programs like Rhode Island. This would, in turn, potentially drive down incarceration rates because fewer people would be using illicit substances, thus providing them with a greater opportunity of employment and eliminating their need to sell drugs for cash.

To view Professor Brockmann's publications, click here.