Privatization of prison healthcare pushed in secret meetings

At the beginning of the session, Gov. Rick Perry tossed out the idea of privatizing prison healthcare, but after the House and Senate budgets slashed reimbursement rates to the same, low levels as the Medicaid program, in my own mind I'd set aside the possibility as a non-starter. I just didn't think anyone would want the business at those payment levels. And I was right, sort of.

Mike Ward at the Austin Statesman, though, reports that secret meetings promoted by the Governor between legislative leaders and private prison companies (with the current university health providers not in the room) have been exploring more seriously the possibility of privatizing Texas prison healthcare. House Corrections Chairman Jerry "Madden said that though vendors and their lobbyists have been pressing in recent weeks for privatization to be considered as an option," though he also added, "I don't know that there's any great move in the Legislature to see things redone."

One pitfall: Privatizing wouldn't actually save money, and in fact would cost more than legislators have said they're otherwise willing to spend. Ward obtained a copy of a "report circulating among legislative leaders  ... which appears to be a draft and has no mark of authorship" promoting the privatization option. (Regrettably, the Statesman did not post it online.) He quotes a critical provision from that document which to me seems virtually to preclude the option: "'Opportunities for the private sector to deliver certain segments of inmate healthcare may be possible if funding levels remain close to the current appropriation levels.' That said, the report notes that funding levels proposed in the initial Senate and House budget drafts 'will not be adequate to satisfy the legal requirements for inmate healthcare and meet the minimum manpower needs.'"

In other words, though legislators intend to slash reimbursement rates by up to 24% after a state auditor's report criticized UTMB for overcharging, privatization only makes sense economically for private companies if funding remains at current, much higher levels. That reality makes the prospect seem unlikely.

It was already an open question whether the levels of funding in the state budget are adequate to provide constitutional levels of healthcare at TDCJ. Ward adds ominously that "During the past 10 years, more than 900 medical positions have been eliminated from prison clinics. Doctors and some prison officials have warned privately that further cuts would be likely to trigger lawsuits over too little care." In that context, I fail to see how it would help maters to add a middleman taking a slice of profit out of the budget pie. The Lege has a lot more control over the situation and a greater ability to demand cost concessions if UTMB and Texas Tech continue to provide care.

MORE: The headline to the AP story on this says "Texas may have to privatize prison medical care."  But there's no "have to" here; this is all about "want to." As mentioned above, privatization as a practical matter may be more expensive because outside vendors won't be willing to provide services at Medicaid rates as envisioned in initial budget drafts.

AND MORE: From the Austin Statesman (3/31): "Idea of private healthcare for inmates meets skepticism."

See related Grits posts:

• Draft budgets reduce prison healthcare reimbursements to match Medicaid rates
• Texas' 'Secret Death Penalty': Inadequate prison healthcare
• Audit: UTMB overcharged state while claiming massive deficit
• Whither Texas prison healthcare with 24% budget cuts?
• Can UTMB provide constitutional levels of healthcare after prison staffing cuts?