Wilbur O. and Ann Powers College of Business

Clemson research links Affordable Care Act to drop in crime


CLEMSON, S.C. – Might there be a link between health care and crime in the U.S.?

Research by Clemson University economists in the College of Business would indicate so.

Barkowski mugshot
Scott Barkowski

Scott Barkowski, assistant professor in the John E. Walker Department of Economics, and Qiwei He, a former Clemson economics Ph.D. student, examined crime rates before and after the Affordable Care Act (ACA) expanded Medicaid coverage. They found crime rates dropped in states that adopted the Medicaid expansion compared to those states that did not. And, the researchers put a dollar value on those reductions in crime.

“I can imagine most people don’t associate health care coverage with crime, but this study provides evidence that they are related,” Barkowski said.

The Affordable Care Act expanded Medicaid eligibility to cover more Americans, extending to individuals with incomes up to 138 percent of the federal poverty level. By 2017, there were 32 states that adopted the Medicaid expansion under ACA.

Qiwei He mugshot
Qiwei He

The two economists’ study, “The effect of health insurance on crime: Evidence from the Affordable Care Act Medicaid expansion,” has been published in the journal, Health Economics.

The researchers examined FBI data on property and violent crimes from around the country between 2010-16. The data represented crimes affecting approximately 98 percent of the U.S. population.

“We found that crime fell in virtually every category in those states that expanded Medicaid coverage. Burglary declined by 3.8 percent, vehicle theft by 10 percent, homicide by 8 percent, robbery by 6 percent and assault by 3 percent,” Barkowski said.

Barkowski said there are theoretical ways that health insurance could affect crime. One of the most straightforward is substance abuse.

“Substance abusers might commit crimes for money to purchase drugs, or for other reasons related to their use. But if they’re getting treatment for the substance abuse, they might be less likely to commit that crime,” Barkowski said. “Crime can also be driven by desperation. If a person has medical bills or is struggling financially, they might be more prone to criminal behavior.”

He offered another, more subtle, example of how health insurance might dissuade a potential offender from committing crimes.

“Imagine a poor, young person getting health insurance from the government for free. If you value that insurance, it makes your life better. It offers you the option for better health,” Barkowski said. “So, why worsen your life by going to jail when your life on the outside has been improved?”

Barkowski and He estimated the reduction in crime resulted in more than $10 billion in societal savings for the expansion-adopting states.

“It cost the federal government $74 billion to expand Medicaid in 2017. The government clearly didn’t expand Medicaid to reduce crime, but there is a positive spillover effect in those expansion states, so it does somewhat reduce the net Medicaid expansion costs.”

Though the researchers stand neutral on whether the ACA should be preserved, they said their research findings suggest health care accessibility may have broader societal implications.

“There may be some natural skepticism around the notion of health insurance affecting crime, but if it is shown to reduce murder, burglary and theft rates, these are real benefits to society,” Barkowski said. “We’re not taking a stand on ACA either way, but if the Medicaid expansion were to be undone, the broader societal impacts should be taken into consideration.”

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