In response to high hospital readmission rates for Medicare
beneficiaries, the Affordable Care Act, through Section 3025, amended the Social Security Act to create the Hospital Readmission Reduction Program
(“HRRP”). Hospitals are now penalized if they readmit a patient for the same
health issue within thirty days of discharge. As a result, hospitals are
incentivized to ensure patients make a full recovery after discharge by
improving care coordination, conducting follow-up visits, and assisting patients to enroll in support services.
However, attorney Karen DeBolt feels
the penalty will do more harm than good, as the penalty is unlikely to significantly improve the overall prognosis
of patients. She questions whether it’s the hospital’s fault a chronically ill patient faces readmission or whether it’s just the nature of the illness. Stuart Butler, a Senior Fellow in Economic Studies at the Brooking Institute, believes the ACA’s readmission penalty scheme would be beneficial if applied to prison recidivism.
The United States has the highest incarceration rate in the world with
over 1.5 million
inmates. As many as 2/3 of prisoners released will be arrested for the same or new crime within three years of release and 3/4 of released prisoners will be arrested within five years. Others assert that while “prisons
exist to protect the public and punish the offender . . . increased attention should be placed on rehabilitating inmates to prevent a cyclic nature of
offense, arrest, release, and repeat.”
Clearly, based on the recidivism rates, the United States is often unsuccessful at rehabilitating inmates. A recent report from the International Journal of Research and Practice on Student Engagement that
occupational programs for developing vocational skills in order to ensure
reintegration into society as working and productive members suffer from budgetary constraints. Furthermore, the report states the availability of rehabilitative services is limited, as 70-85% of incarcerated individuals need alcohol or substance abuse treatment, but only 13% actually receive treatment.
Butler argues that prisons have no incentive to help inmates prepare to re-enter society, thus the recidivism penalty, which penalizes prisons that fail to rehabilitate inmates, would incentivize prisons to increase efforts to rehabilitate its inmates. Butler envisions the recidivismpenalty to function much like HRRP: "[I]f
an unusually high number of released inmates from a particular prison were
convicted and sent back to prison within three years then the prison’s budget
would be cut and the bonuses and salary increases of senior prison staff
trimmed back.”
Obviously inmates must be held responsible for the crimes
they commit. This approach in no way takes away that responsibility. Instead,
the recidivism prison penalty seeks to punish prisons for failing to
rehabilitate prisoners. But is it fair to hold the prison staff liable for
unsuccessful attempts to rehabilitate inmates? Do prisons have an ethical
responsibility to rehabilitate inmates so that society is ultimately safer? If
so, then isn’t it fair to punish the prison for failing to fulfill their
ethical duty? Butler believes so. He states that after complaining of the
“unfairness” of being held liable, “[p]risons would get serious not only about
training inmates but also about working with potential employers to help line
up jobs. Instead of dumping released
prisoners on the street, prison managers, like today’s hospital managers, would
become more interested in arranging stable housing for their ex-customers.”
But,
what if, like Karen DeBolt claims, the unsuccessful rehabilitation is just the
“nature of the illness.” What if it’s not the prison’s fault that an inmate has
not been rehabilitated and has committed another crime, but rather the inmate
resists rehabilitation because he or she does not want to change?
Ph.D. Economist Jason Shafrin, while he is more reserved
than Butler regarding his confidence in this approach, states, “[i]t
certainly would provide some incentive to refocus prison from a place of
punishment to a place of rehabilitation. It may be worth a try Kathryn Brown is
second year law student at DePaul University College of Law and is expected to
graduate in May of 2017. Previously she
studied Political Science at Saint Ambrose University where graduated summa cum
laude. She is a Fellow for the Jaharis
Health Law Institute, contributor to the Institute’s E-Pulse blog and staffer
for the DePaul Law Review.