In October 2011, when Texas enacted a law instituting a $100 annual copay for state prisoners seeking medical care, it was estimated the measure would generate $5.7 million in 2012 and help the cash-strapped state deal with a budget crisis. [See: PLN, Oct. 2012, p.42]. Instead, only $2.5 million was collected that year. Since the prison system’s prior $3.00 medical copay had generated $500,000, the net gain was $2 million – less than half the anticipated amount.
“Quite frankly, it doesn’t make much of a difference,” stated Dr. Owen Murray, vice president for Correctional Managed Health Care at the University of Texas Medical Branch, which administers medical treatment for over two-thirds of the state’s prison population. “The financial expectations for the program have not been met.”
In fact, the new law might be increasing the burden to taxpayers with respect to prisoner health care. In a classic case of unintended consequences, the cost of medical treatment may be higher as many Texas prisoners avoid seeking medical attention in an attempt to avoid the $100 annual copay. Sometimes, this allows an easily-treated-if-caught-early condition, such as a staph infection, to advance to a serious and expensive-to-treat emergency.
Under the previous system, Texas prisoners were charged $3.00 each time they asked to see a health care provider for non-chronic reasons. They are now charged $100 the first time they request such medical services, which covers their health care fees for one year. If a prisoner seeking medical attention has less than $100 in his or her trust fund account, half the balance in the account is taken along with half of all subsequent deposits until the entire $100 is collected.
The problem is that the vast majority of Texas prisoners, while forced to work if medically able, are not paid for their labor and have no income. Most prisoners rely on funds sent by their families, who also tend to be impoverished, and therefore have little money in their trust accounts. Consequently, they may have to choose between buying commissary items – such as toothpaste, soap, shampoo, food or a fan – and obtaining health care.
“Because they get so little commissary money, they try to avoid going to medical treatment at all costs,” observed Jennifer Erschabek, head of the Austin chapter of the Texas Inmate Families Association.
“My big question is whether that copay is really saving any money,” added Michelle Smith, an attorney with the Texas Civil Rights Project who works on prisoners’ rights cases, “because more serious complaints that develop from lack of early detection end up costing more in the long run.”
In 2012, Smith arrived for a court hearing only to discover that her prisoner client wouldn’t be attending. Instead he was in an emergency room, fighting for his life.
“He thought he just had the flu and wasn’t willing to pay $100 to get it treated,” said Smith. “It turned out he had pneumonia.”
State Rep. Jerry Madden still defends HB26, the $100 medical copay bill he authored.
“I believe it was the right thing to do at the time. I still think it’s a reasonable thing to do,” he stated. Rep. Madden acknowledged, however, that “there is some tweaking that needs to be done.”
One possible tweak would be to simply release the 10 Texas prisoners with the highest health care costs, which would save the state approximately $1.9 million per year. Or the $100 annual copay could be rescinded entirely. Meanwhile, the burden of the cost of the copay mainly falls on prisoners’ family members.
“Families who can pay, will,” said Erschabek, “because they’ll do whatever it takes” to ensure the wellbeing of their incarcerated loved ones.
According to a public records request filed by Prison Legal News, the Texas Department of Criminal Justice collected $1,552,281.87 in medical copays from state prisoners in fiscal year 2014 – less than .05% of the department’s annual budget.
Sources: Texas Tribune, Texas Department of Criminal Justice
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