Tuesday, October 16, 2012

Bleeding the Poor for Healthcare

I've lectured students over the years that one of the great, cruel ironies of healthcare in the U.S. is that inmates are the only group of people in the entire country who get free, 100% unfettered access to healthcare. No co-pays, no premiums, no deductibles.

Except Texas (damn straight) has changed that now:

As a result of HB26, which took effect last year, TDCJ prisoners who seek medical care now pay a fee of $100 once a year, whether they see a doctor once or multiple times. But if they don't see a doctor at all, they can avoid the fee altogether. Critics of the new law, though, say the fee has had unintended consequences — including situations where inmates are refusing treatment and a complicated administrative process for inmates who say they have been charged incorrectly. The fee, these critics say, hasn't even met financial expectations.

Lawmakers who supported the policy change say the goal is to take the burden off taxpayers to pay for inmate health care. “I believe it was the right thing to do at the time,” said state Rep. Jerry Madden, R-Plano, who wrote the bill. "I still think it's a reasonable thing to do."

Madden explained that at the time the bill was passed he and other lawmakers considered the possibility that inmates would forego treatment. After a year of seeing the policy in action, he said, legislators may want to revisit the fee and make changes.

TDCJ spokesman Jason Clark said that the medical fee is charged to the offender's commissary, or trust fund, account. “If there is not enough money in the trust fund account, the law requires that 50 percent of each deposit to the offender’s trust fund account must be applied to the amount owed until the total amount is paid,” he said. That means when inmates get commissary money from their families, half is taken out if they’ve seen a doctor and haven't paid the entire fee.

And if they don't, well they just die.

Kidding. They make exceptions for inmates who have less than $5 in their accounts, but won't say how many that actually affects (my guess, based on their projected v. actual amount of money taken in, is the vast majority).

And bonus irony: one of the unintended consequences of the fee is that once the inmates learn that it covers all doctors visits for an entire year, many are making multiple appointments to game the system.

Regardless, all of this violates the spirit, if not the letter, of the Supreme Court's Estelle v. Gamble (1976) decision that guaranteed healthcare to inmates. If you read the case, the court's reasoning was quite simple: it violated the 8th amendment to deny inmates access to healthcare, and it imposed an undue burden on the inmates and their families (all of whom are poor) to pay for health treatment while incarcerated.

But not in Texas, by gawd, where healthcare ain't no right, even if you're in the Big House.

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