Inside Cook County Jail, where inmates get Obamacare

  • Cook County Jail in Chicago, Ill. is the largest jail in the country. More than 10,000 people who’ve been incarcerated at some point now have health coverage as a result of applications that got started at Cook County Jail.
  • Trinidad Sanchez, 33, says he used to commit crimes just to get medical treatment. Katherine Rodgers, 49, right, would routinely wait for upwards of 11 hours at Cook County Hospital to get medication. 
  • Cook County Jail is among the growing number of states and municipalities that are helping enroll individuals in Obamacare’s Medicaid expansion through the criminal justice system.
  • Uninsured offenders passing through Cook County jails intake have an opportunity to take part in CountyCare. This is a Medicaid program through the Affordable Health Care Act.
  • Illinois was one of the few states to get the obama administration’s permission to expand Medicaid early, beginning enrollment in Cook County in 2013. 
  • Offenders in holding cells wait to get their prescription medications. The hope is that expanded health coverage will ultimately help address the untreated mental illness and drug abuse that help lead individuals to his custody.
  • Tom Dart, the current Sheriff of the Cook County Sheriff’s Office, believes that Obamacare could keep more Chicagoans out of his jail.
  • The move to help enroll individuals in Obamacare’s Medicaid expansion through the criminal justice system would not only expand insurance coverage, but also shift the cost of emergency care for inmates from the state to the federal government.
  • Natrik Washington, 43, has been chronically homeless since 2003. He was hospitalized after his last stay at Cook County Jail for a suicide attempt.
  • Natrik Washington spent years living in abandoned buildings like these in the North Lawndale neighborhood of Chicago while homeless.
  • Natrik Washington opens his locker at the Heartland Alliance Outreach Center, where he is able to get medication and which has also helped him find shelter.
  • Natrik Washington retrieves his belongings from a small locker in a homeless shelter where he once lived. He is currently receiving health care through the Affordable Health Care Act, which he signed up for when he was incarcerated at Cook County Jail for stealing Tylenol and deodorent from Walgreen’s to support his heroin and cocaine habit.
  • Sober for a year - the longest time he’s been clean in 12 years - Natrik Washington, right, has health care and is moving into a place of his own. Heartland Alliance, a social services organization in Chicago, provides Washington with medication and helped him find a small apartment in the building on the left. 
  • Before Washington had health care and the help of Heartland Alliance, abandoned buildings like these in Chicago’s North Lawndale neighborhood provided shelter and safety.
  • Natrik Washington in his new apartment complex in Chicago.
  • Abandoned Buildings of Chicago’s North Lawndale neighborhood.
  • A view of Cook County Jail. Sheriff Tom Dart believes Obamacare could keep more Chicagoans out of his jail, which he describes as the largest mental health provider in the state. 
  • Natrik Washington leaves the homeless shelter where he once lived and heads to a space of his own. With health care and place to live, Washington feels better about his future. “I’m feeling better mentally,” he told MSNBC, “so I don’t think I’ll relapse and have another suicide attempt now.” 

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A growing number of jails are enrolling inmates in Obamacare’s Medicaid expansion in hopes of reducing recidivism and health-care costs.

They’re trying to reach individuals like Trinidad Sanchez, 33, said who said he committed crimes in the past just to get mental-health treatment.

“Every time I ran out of medication, I just went and bought a gun, and I got caught with it,” says Sanchez, who started hearing voices when he was he was a young boy. When he left jail, however, he’d only get standard three months’ supply of medication, prompting him to start the cycle of crime all over again. 

Having spent nearly half his life in jail or prison, Sanchez is now in the process of signing up through CountyCare with the help of Thresholds, a mental health services provider he found through his probation officer. “Then I ain’t got to worry about going to jail to get my medicine,” says Sanchez, who’s never had health insurance as an adult.

RELATED: Jails are signing up inmates for Obamacare

Chicago’s Cook County was one of the first places in the country to enroll residents in the Medicaid expansion through the criminal justice system. It’s now joined by counties in California, Connecticut, Oregon, and other states that have chosen to expand Medicaid through Obamacare.

Natrik Washington, who got out of Cook County Jail in late 2013, has reaped some of the benefits of being insured. Washington, 43, was hospitalized after his last stay time in jail for a suicide attempt and enrolled in Illinois’s Medicaid expansion last year.

 “There’s nothing worse than not being able to get the medication you need,” he said. 

Washington, who said he’s been chronically homeless since 2003, had stolen some Tylenol and deodorant from Walgreen’s to sell in order to fund his heroin and cocaine habit. Now he says he’s been sober for a year—the longest time he’s been clean in more than a decade—and can pick up his anti-depressants at an ordinary pharmacy. 

“I’m feeling a little better mentally, so I don’t think I’ll relapse and have another suicide attempt now. I feel a little stronger mentally since I don’t get high. I’m learning to be patient,” says Washington, who now sees a psychiatrist regularly and goes to group counseling sessions at Heartland Health Outreach, which serves low-income and homeless residents in Chicago. 

Carlos Javier Ortiz is a documentary photographer based in Chicago. He recently published the book, “We All We Got”. 

For more feature photography, go to msnbc.com/photography

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