Lege has few answers on how to cut prison health costs

The debate over proposed cuts to prison spending has so far seemed rather surreal, with the Governor and officials in both the House and Senate proposing massive, nine-figure cuts while the Legislative Budget Board predicts an expanding number of prisoners, with little public discussion of how to pragmatically reconcile the situation. Perhaps the most obvious example is prison health care, where cuts risk diminishing inmate medical care to unconstitutional levels. Mike Ward at the Austin Statesman has an article titled "Options running out for prison health funding," in which we learn that nobody really has a plan (surprise!) for how to implement proposed cuts to prison health care. "Right now, I don't have an answer," said Senate Finance Committee Chair Steve Ogden.

Prison health care officials said much of the mushrooming costs is being driven by the fast-growing number of older prisoners — about 23 percent of prison medical costs stem from care for convicts age 61 and older — and those with illnesses that are expensive to treat, such as HIV, AIDS, hepatitis C, kidney diseases and cancer.

Among some lawmakers, there remains hope that a number of budget amendments and separate bills could slow the costs — through a "healthy prisons" initiative designed to improve diets and exercise regimens that could save $13 million and by requiring convicts who can afford it to pay $100 a year for their care, among others.

A bill by state Rep. Senfronia Thompson, D-Houston, would speed up paroles of low-risk convicts who are terminally ill, require long-term care, are in a vegetative state or are immobile because of a medical condition. The bill is scheduled for a public hearing today in the House Corrections Committee.

The Governor wants to privatize, but vendors have said they'd be unwilling to perform such services at Medicaid rates, which is the level at which prison healthcare would be reimbursed under both proposed budget plans. To privatize, they'd have to keep prison health spending at or near current levels, which nobody seems willing to do, particularly after the state auditor criticized UTMB earlier this year for allegedly overcharging the state.

Texas' per-inmate medical costs are already among the lowest in the nation, while long sentences have boosted the number of more expensive, older prisoners. The best and arguably the only way to cut costs further is to reduce the number of inmates, particularly those older, Medicare-eligible inmates who require the most intensive services. None of the other suggestions I've seen tossed out on this question seem reasonable, or in most cases even remotely plausible.