One way to help the Affordable Care Act meet the administration's goal of seven million enrollees is through the prison system.

According to the National Association of Counties, about 90 percent of inmates of the estimated 13 million people who are booked into county jails each year are uninsured, and many have never had treatment for their illness. A new study shows counties in six states are enrolling inmates in the ACA health plans as a way to shift costs to the federal government.

It costs states more than $6.5 billion annually to treat prisoners. Many of them have a high rate of communicable and chronic diseases and behavioral disorders. According to the National Alliance on Mental Illness in Arlington, Va., about 488,000 people in U.S. prisons and jails suffer from a mental illness.

Proponents say providing health care to inmates benefits the community since it decreases the likelihood they'll return to prison. San Francisco Sheriff's Department, one of the first county jail systems in the nation to enroll inmates into the ACA, projects a 20 percent reduction in future arrests for inmates who are enrolled in health care programs before they leave jail.

Republicans present another side, pointing to the already skyrocketing costs. One senator said the first jolt was learning that the ACA would cost $2 trillion over 10 years.

"Now, we're going to have local governments picking our pockets to pay for their jail inmates? What a disgrace," he stated. "When the president gets excited about enrolling a few million people, it makes one wonder how many of them are criminals?"

Kent Conrad, a former Senate Democrat from North Dakota, was on the Senate Finance Committee when the ACA passed but doesn't recall discussions about the law's being used to cover inmates. While he agrees that it's better to have as many people as possible insured, including prisoners, he's not keen about federal taxpayers picking up the tab for inmate hospital stays. He said it looks like a scheme by the states and local governments to avoid responsibilities that are really theirs.

Insuring prisoners is just one more point of dissension for the Affordable Care Act, the dominant issue leading up to the midterm elections.

By Jim Zbick

editor@tnonline.com