The answers could determine whether the Texas Lege can reduce the line item for prison health spending in the next biennium, or if they must increase it by a nine-figure sum. Here's how Stateline.org described the new option to cover state prisoners' hospital bills under the federal Affordable Care Act:
most state prisoners (currently) do not qualify for Medicaid. That's because all but a few states limit Medicaid to low-income juveniles, pregnant women, adults with disabilities and frail elders. The majority of people in lock-ups are able-bodied adults who do not qualify, even on the outside. In 2014, however, when Medicaid is slated to cover some 16 million more Americans, anyone with an income below 133 percent of the federal poverty line will become eligible. Since most people have little or no income once they are incarcerated, virtually all of the nation’s 1.4 million state inmates would qualify for Medicaid.So the question arises: Will the Texas Legislature expand Medicaid in 2014, or will the state thumb its nose at the new law and abstain from accepting additional federal healthcare money? Given that the feds would pay 100% of the costs until 2019, not to mention the fact that expanding Medicaid would allow the state to pawn off a great deal of prisoner healthcare costs on the feds, there will be terrific fiscal temptation to accept the subsidies. OTOH, Governor Rick Perry, Attorney General Greg Abbott, and many Republican legislators have staked out extremist positions against Obamacare, and the state could choose to reject the money on principle. That's a bit like cutting off one's nose to spite one's face, since Texas taxpayers would then be in the position of subsidizing healthcare in other states while failing to receive any of the benefits, not just in expanded coverage for free-world Texans but in reduced state prison health costs.
As a bonus to state corrections agencies, most inmates would be considered new to Medicaid, making them eligible for 100 percent coverage by the federal government between 2014 and 2019. After that, states would be responsible for only 10 percent of their coverage. In addition, state health insurance exchanges—which are required to be functioning by 2014—would make it easier for corrections departments to sign inmates up for the program.
Though the feds will substantially up their subsidies in 2014, covering inmate hospital care through Medicaid is something some states are already doing. Reported Stateline.org, "Dr. Gloria Perry, the chief medical officer for the Mississippi prison system, says her agency heard about the cost-cutting measure from a health care vendor looking for business in the state. The agency then verified the legality of the procedure with the state Medicaid office and quickly created a reimbursement program. No state laws or appropriations were required."
Given the US Senate's filibuster rule, where 60 out of 100 votes are needed to pass legislation, I don't see the federal healthcare law being repealed even if Mitt Romney is elected President and Republicans reclaim the US Senate, despite a great deal of chest pounding to the contrary on the campaign trail. The battle over implementing federal healthcare legislation has now shifted inexorably to the states.
Whether Texas will accept billions in federal subsidies to expand Medicaid as envisioned under Obamacare will be one of the biggest political debates of the 83rd Texas Legislature. And at the end of the day, Grits wonders whether the deciding factor won't be the new law's effect on prisoner health care costs.
RELATED (6/29): In the Fort Worth Star-Telegram, columnist Bud Kennedy had some kind words to say about this item. "Of all the blog posts and blather Thursday on both sides of the Supreme Court case, one of the most incisive comments came from Austin criminal justice blogger Scott Henson," he wrote, concluding, "I give him credit for thinking before shouting."
Regrettably, though, there was an error in Kennedy's recitation of the effect of Medicaid expansion on state prison healthcare costs. He declared that "the federal government would pick up 90 percent of the state's nearly $500-million-per-year prisoner healthcare costs." In fact, as Grits understands it, the Medicaid expansion would only cover hospital costs for prisoners, not in-prison clinics or other health services delivered on-site. That would still be a quite-large sum, but Medicaid would not cover all prisoner health costs.
According to a state auditor's report (pdf) published in 2011, hospital services account for about $16% of Texas prison health costs - roughly $150 million per biennium. Also, Texas runs its prison pharmacy through UTMB-Galveston's hospital system, but Grits can't tell without more research whether pharmacy costs would be covered by Medicaid under that scenario: It's possible. Notably, Texas underfunded prison healthcare in the current biennium by more than $100 million, so while Medicaid wouldn't pay for all prison health costs, it would plug the state's short term prison health deficit. Otherwise, the only way to reduce prison health costs in the state budget is to reduce the number of people Texas incarcerates.
See prior, related Grits posts: