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Texas Prison Health Care Costs at Record High Despite Population Reduction

Despite a reduction in the Texas prisoner population, state prisons are spending record amounts on prisoner health care. The reason is not an improvement in the health care afforded prisoners. Pending lawsuits allege inadequate health care — especially for Texas prisoners infected with the Hepatitis C virus. Instead, the driving factor in rising prisoner health-care costs is an aging prison population that is costing more to care for.

In FY 2019, Texas Department of Criminal Justice (TDCJ) prisoner health care costs exceeded $750 million. That is a 53% increase over FY 2012, when the costs were less than $500 million.

During that period, the TDCJ prisoner population declined by 3%, but the number of prisoners over the age of 54 increased by 65%. The prisoners who are 55 and older make up one-eighth of the prisoner population, but account for almost a half of TDCJ’s hospitalization costs. This increasingly costly older prisoner population swamped cost-saving measures, such as increasing the use of telemedicine and using discounted medications implemented by TDCJ’s health-care providers.

The reason the Texas prisoner population is aging is not because more older people are being prosecuted for crimes in Texas. Rather, it is because the Texas parole board refuses to grant parole to many prisoners, even after they have “aged-out” of criminality. In other words, older people — especially those over age 60 — are known to be at very low risk of reoffending.

Nonetheless, the Texas parole board insists on keeping many older prisoners incarcerated long after the age of 55 and sometimes after 65.

The reason for retaining low-risk elderly prisoners in TDCJ may be because, as recently shown by a Texas criminal justice blog, Grits for Breakfast, the parole board adjusts parole rates to keep the huge — nearly 150,000-bed — Texas prison system at full capacity. This means that successful programs Texas implemented to keep certain criminal defendants out of prison have made it more difficult for those already in prison to be granted parole.

Whatever the reason, the bulging population of elderly prisoners is straining TDCJ’s budget. The high cost of treating prisoners infected with the Hepatitis C virus or HIV is causing additional strain.

That is likely to increase as a class-action lawsuit alleging TDCJ denies its 18,000 prisoners known to be infected with the Hepatitis C virus effective medication until their livers are damaged instead of providing them with direct-acting antivirals as soon as they are diagnosed, which is the proper standard of care.

The only practical way to reduce TDCJ’s prisoner health-care costs lies in increasing the rate of parole for elderly parole-eligible prisoners and compassionate medical parole for seriously and terminally-ill prisoners.

“Well, nobody’s tougher on crime than me, but once you’ve incarcerated a guy past the point that he’s a threat to anybody, I’d like to save that $500,000 to put him in a nursing home as a condition of parole, take that money, and spend it on either other public safety efforts or prison costs,” said state Sen. John Whitmire, chairman of the Criminal Justice Committee in the Texas Senate. He admits that understaffing makes TDCJ’s provision of health care “very questionable” at times.

An ongoing federal lawsuit alleges that understaffing results in unconstitutionally inadequate health care in TDCJ. The University of Texas Medical Branch (UTMB), the primary provider of health care in TDCJ, admitted in late 2019 that about 300 of its 3,100 full-time positions remain vacant.

Texas has a form of medical release for prisoners who are terminal or have serious physical or mental impairments. According to Dr. Owen Murray, UTMB vice president for Correctional Managed Health Care, all qualified prisoners are referred for medical compassionate parole — over 2,100 in 2018. Of those, only 63 were approved.

“It’s not that we don’t have a lot of people that meet the clinical criteria,” said a TDCJ spokesman. “It’s just that, unfortunately, most of those guys have an offense that won’t let them get considered.”

That statement illuminates the core of the problem. The Texas Board of Pardons and Paroles refuses to grant parole to most TDCJ prisoners who were convicted of violent crimes. Those prisoners remain in TDCJ, often for many decades, driving the aging of the prison population and increases in health care costs.

Prisoners convicted of non-violent offenses are generally diverted from prison or paroled rapidly, making them an ever-smaller portion of the prisoner population. A reduction in the population of aging TDCJ prisoners cannot be achieved without addressing those convicted of violent crimes.

“Most of those gray hairs, if they get out, aren’t going to take their walker and go on a crime spree,” said Scott Henson, executive director for Just Liberty, a criminal justice reform nonprofit, noting that many elderly prisoners have long sentences for serious crimes but no longer pose a public safety risk.

“I think a lot of the low-hanging fruit has already been trimmed,” said Marc Levin, vice president of criminal justice at the Texas Public Policy Foundation. “It’s always good to look for other efficiency options, but I do think to some degree, if we don’t address the prison population and medical parole issues, we’re kind of going to be tinkering around the edges, as far as achieving a cost reduction or even just holding the line.”