Tuesday, June 21, 2011

Will new healthcare tax on inmate families boost demand for prison medical services?

Reports AP:
The Texas House has approved legislation meant to tamp down rising health care costs for the state's prisoners.

Passed by a vote of 124-14, the bill requires inmates who initiate a doctor's visit to pay a $100 annual fee, unless they are indigent. It also requires the Texas Department of Criminal Justice to house inmates with similar health conditions in the same units, so as to help reduce costs.

The measure additionally directs the department to provide some over-the-counter medications and at no cost to indigent inmates. It now heads to the Senate.

Opponents say the bill is too much of an increase from the current, $3 prisoner co-pay per doctor's visit. But a budget analysis predicts it will save Texas nearly $10 million over the next two years.
Two points: First, the state doesn't "save" money under this plan, it just generates more revenue from taxing inmate families by seizing money from commissary accounts. Referring to a new tax as "savings" is downright Orwellian.

Second, in past Grits comment strings, medical professionals working at Texas prisons have questioned whether this policy will increase demand for services thanks to changed economic incentives. Presently, many younger, relatively healthy inmates use relatively few medical services. But if they think they're already paying for it, anyway, they may be more likely to ask to see a doctor or nurse for relatively minor complaints. Of course, the $100 doesn't come close to paying for the true cost of their medical services, but from the inmates' perspective, folks who previously paid nothing will now pay $100, and those who previously factored in the cost of a $3 copay now will think to themselves, "Well, I've already paid for the services, I may as well use them." Time will tell, but there's a real risk this move will boost overall medical costs significantly more than the $10 million raised from new taxes on inmate families.


Texas maverick said...

Our family's strategy is to not buy from the commissary for the month of Sept when the $100 medical is deducted. It will be difficult and requires planning ahead. We will buy phone service, envelopes and stamps and coffee in august, but nothing in Sept. so you may gain $100 in the medical fund but you will lose profits from commissary purchases. If everyone does this, it will backfire. I'm working on the protest as we speak.

aninmateswife said...

I am the one that puts money on my husband's books. I also pay for our child's insurance on my own. I have never received any government assistance. I take care of my family without his help. He would help if he could. The state is holding him, he can not change that. He can not work for his own money. It is my money on the books paying for the services. The state receives free labor from inmates to cover these type of expenses, isn't that part of their justification for not paying inmates? My husband may receive work time, but it is meaningless because he has an 3g charge.

I take care of our family on my own, without the help of the state. Why is the state asking me to help pay for him when he is held there without pay? Depending on what is offered in commissary he may not have to go to the doctor any more, but that is only if they offer allergy medications. The money I put on his books is to purchase food because what he receives does not meet his nutritional needs. So I have to assist with paying for his food and now I have to help pay for his healthcare. It is not him paying, it is me. Maybe the AG needs to ask the prison pay me child support.

DeathBreath said...

Welcome to Jesusland. Yes, in this new world, all problems need to be directed to Jesus. Pretty Boy Perry will be hosting a prayer orgy called "The Response" in order to channel funds into the Texas Comptroller, just like manna.

Now, Pretty Boy Perry & the buffoons in the Texas Legislature are wanting parents to pay for medical care? You could call this penance for having children. You see, the Religious Right cares about your child before birth, not after. But, the American Family Association is hosting "The Response, I thought they were Christians?" Yes, but if you son or daughter went into prison, there is an increased likelihood that homosexual behavior occurred. The American Family Association does not condone such behavior.

So, brothers and sisters, get the prayer cloth out because this is going to be a bumpy ride.

In my opinion, Pretty Boy Perry needs to be concerned about who comes out of his closet, doesn't he?

jimbino said...

I think it poetic justice that inmates have found a way to retaliate against our fascist nanny state! A state that has charged outrageously for simple phone calls and commissary purchases.

I will do all I can to help inmates game the system and bring it down.

Prison Doc said...

No offense Jimbino, but I doubt that any of these offenders need your help...most are quite adept at gaming the system anyway.

The old $3 charge was worthless in every way. It was not a deterrent to unnecessary visits, cost more to collect than it brought in, and was rarely charged, even more rarely collected, and often refunded if any complaint was made. The $100 annual charge may bring in a lot of money; I doubt it will have much other lasting effects. No one is ever denied needed care and won't be in the future.

Most providers are philosophically opposed to charging inmates for care.

jimbino said...

Prison Doc:

What has TDJC undertaken to provide the atheist chaplains that the atheist/humanist/freethinker inmates need and deserve?

Nurseypooh said...

I agree with prison doc!
The $3.00 charge has done little to stop uneeded visits. I doubt if they pass the $100.00 charge it will come out all at once, possibly spread out over several payments.

What offender families should be more concerned about is the cuts that have or about to be made to offender care. 3000 specialty clinic appt. at HG were cancelled across the board. 168 jobs within correctional managed care will be cut by June 29th. Hours of operation have been cut, 43 units which operate at 12 hours per day will be cut down to 8 hours per day now. They will only have 1 pill line per day.
Insulin dependent diabetics and high acuity pt.s will be moved to units which operate at 12 to 24 hrs per day.
Policy and Procedure will be revised.
Texas is alloting $7.75 per day to provide medical care for each offender. This amt. is the lowest in the U.S. with Ca. alloting $45.00 per day.
I expect these changes to be hard on everyone concerned.

sunray's wench said...

Maverick, read the Bill text carefully: if the inmate does not have sufficient funds for a single $100 payment, the money will be taken at 50% from any subsequent deposits on the inmate's books until the $100 for that year has been paid to the state. The text also says that this is an ANNUAL payment, which makes it even more of a tax, and that in 2015 the $3 payments will be reinstated (if i read it correctly) on top of the $100 annual payment. Finally, the text says that if there is a surplus of funds at the start of the following year, then this money will be paid straight into the State's central fund - not used for any TDCJ pruposes at all.

If it walks like a tax, talks like a tax and craps all over everyone like a tax, then I think we can safely say that it is a tax. And I am just as insensed as aninmateswife, because I am not legally required to pay tax in the USA (I can claim it back if I keep receipts during any visit there) and I will now have to pay for my husband's $100 inmate medical tax out of my already taxed income.

Anonymous said...

Why are they complaining about the $100 charge, I and I know just about everyone in the free world working, we pay more then that in just a short time, are co-pays are from $25 to $50 per visit, we have to pay for medicines (we dont get them free like inmates) and they complain, the HG referrals that have been cancelled are due to problems that these inmates are have for 2 to 3 years, but when they were in the free world at that time, they did nothing to have their medical issues taken care of, but as soon as they are locked up again, they are demanding that this be taken care of ASAP. We need to hold inmates accountable for their own actions. Any families are very concerned once they are locked up and demanding care for them also, Well I say "why didn't these families care about loved ones when they were free, because if they did, maybe they would not be in the TDCJ system again, again and again.

Anonymous said...

This is just a small indication of the fact that the whole prison system is imploding. TDCJ is badly understaffed,with no relief in the foreseeable future, UTMB
is chasing away good help,
I give it 6 months before the roof caves in and lawsuits start piling up or the Fed steps in. Lots of good people are leaving
before all this gets underway. By the next legislative session the whole Jail system will be in tatters.

Nurseypooh said...

Ano 5:36
One of the new policy changes proposed is just that one you mentioned.
They will stop treating conditions that they came in with such as dislocated toes, finger's and elbows which had been this way for 2-3 yrs and once they come into the system they want it fixed.
I personally would also like to see them stop treating things such as acne (unless severe), dandruff, dry skin, shipping fake suicidal offender's to crisis managment the list could go on.
As a nurse though there are things I see that need and get treatment and some things that don't.
All these changes look good on paper but in reality I doubt it will work. It may take a year or to for them to realize it and change things. Yes utmb is going to loose some good people in the rift and voluntarily when some of these changes make working there more difficult and make them fear for keeping their medical license.
Offender's are human being's and someone's daughter, son, father, mother, sister's and brother's they do deserve humane medical treatment because as a incarcerated individual they can't
have freewill to obtain things as in the freeworld. So the state is responsible for them while incarcerated. For instance:-legally there is no such thing as consensual sex in prison. It is a crime.

aninmateswife said...

Anon 5:36: You typically pay that $25 copay through an employer sponsored health insurance plan. Typically employees pay their portion of their healthcare fee through deductions from their PAYCHECK that they receive from their employer. They use money they earn through their employer to pay for copays. You can go to the store and purchase allergy medications or tylenol if you need to at the local drug store or even a convenient store.

My husband must request a medical visit to obtain his over the counter medications. He doesn't have a paycheck. He earns no money while being incarcerated. The only people that could be paying these fees are the ones that are crucial to the inmate's success upon release. If I decide I can't do this anymore because I just can't afford for TDCJ to continue to charge ME money on top of everything else I am paying for my family, then the chances of reoffense upon release increase significantly.

If you want the inmates to pay then allow them to earn money, even if it is an insignificant amount. But don't charge me extra fees because I am standing by him.

sunray's wench said...

Anon 5.36 said: why didn't these families care about loved ones when they were free, because if they did, maybe they would not be in the TDCJ system again, again and again.

Dear, sweet, misguided Anon. If caring about someone automatically kept them out of prison, then there would be next to zero inmates. There is a BIG difference between caring about someone, and having the ability to prevent them from commiting a crime or even just being with the wrong people in the wrong place at the wrong time.

If the state chooses to ignore common sense and take the incarceration option over any other sentence in the majority of cases, then the state must provide all reasonable care for those inmates.

Nurseypooh, I agree with you, anything that is not a degenerative condition or can be treated with over the counter medication with the exception of chronic diseases that cause a high instance of pain or mental disturbance, should not take up the time of medical staff.

PirateFriedman said...

Ah the struggle over prison healthcare. The quaint battle between the system and the little monsters.

sunray's wench said...

Could someone in TX put in a Public records request to find out how much interest TDCJ /the State made out of the money in all inmate trust funds last year. They must be making a pretty penny out of it, but they don't give any interest back to the inmate's account.

Nurseypooh said...

Sunrays wench: Thank You!

Texas maverick said...

Sunray: No interest because it's going into the general fund. Originally, the profits were to benefit the inmate recreation. Like all laws setting up directed funds, that has gone by the way side.

If I remember, Grits correct me if my memory is wrong, this leg decided to do away with designated funding. If it didn't pass it was discussed. You can bet the extra money generated from the increased phone minutes will soon be going into the general fund.

aninmateswife: the closed minds in Texas just don't want to hear us - WE ARE PAYING for ourselves and now for the inmates. You and Sunray are correct, the state assumed the responsibility for the healthcare when it decided to "lock em up." courts have repeatedly said they have the responsibility for healthcare. What part of this do you not understand, we pay for shoes, socks, underwear, and many other personal hygiene items, these are not free. I live on a very reduced income and from saving and IRA because the Federal level decided they could put off the Social Security crisis by denying payts to inmates. Guess what, didn't work and neither will this $100 deductible.

cheenna said...

There will be no "getting around the system" as some have suggested. If the funds are not there at the appointed time then they will just be taken later as funds come in. If I've not been able to send money for one reason or another, my son gets indigent mail and medical but, the minute I do send money, all past indigent is taken from the top. I think it really, really SUX that the great State of Texas can not pay even 20 cents an hr for the work of the prisoners as other states do. Prison is supposed to be punishment, not slavery. And, we should be able to send in from approved venders, quarterly, clothing and such as other states do. The price and quality of crap they sell inside is insulting. I'm not talking name brands, just decent workmanship would be nice. They don't heat the prisons so let them at least have long johns that last thru more than a few washings. Texas should be ashamed ... Now this for medical whether they use it or not, I can only imagine what the mark up will be on OTC meds.

sunray's wench said...

Maverick ~ but if the money is not hidden under a mattress somewhere, then it must be in a bank account, and as such, it must be earning interest. TDCJ / the State must know how much there is in total in the inmate's trust funds, so it shouldn't be too difficult for them to calculate how much interest it is earning the State.

Nurseypooh said...

Cheena-Heat is provided in TDCJ prison's, a few even have a/c.

From what I can tell there is not much mark up on commisary goods but I do agree on the low quality on some of the items. The food though ranges from good ole blue bell ice cream to squeeze cheese (eech) which I don't care for but the offender's love it combined with other things they put together to make a spread (casserole). Some things are cheaper and some things a little more expensive in commisary.

Sunscreen just became available in commisary at our unit and it is $7.00 for a large bottle, not a bad price, it's high at wal-mart also. They also have cold/allergy meds there for purchase or they can come to medical.

As a nurse I don't see how charging them for medical care has accomplished anything. Policy should be changed to prevent those who abuse the medical services so we can concentrate more on those that truly have legitamate complaints and needs.

If an offender has lets say a spider bite (so they call it) it's usually a boil (staph) I'd rather them come to medical early on so we can begin antibiotic treatment and wound care rather than them postponing it due to a charge only to come later and it be so bad it's difficult to treat and heal or even worse has to be debrided or sent to the hospital due to it spreading. WE also have other inmates in the bldg's and dorm's who have past medical exp. that try to doc welby other inmates giving bad advice! I've never ever charged $3.00 for an inmate coming in for a boil or such like that because they needed to come in early and if it's staph it falls under infectious disease which we do our best to control in a large population.

Anonymous said...

As of last week was told 17 million in offender trust fund accounts that is held by TDCJ.

Texas Maverick said...

Ever wonder how much profit TDCJ makes on Hot Pots?
> http://www.window.state.tx.us/procurement/ompo/pos/0-000009.html

PO 09-000009 - 09/01/09 renewable each Aug.
West Bend #045-20 5 cup hot pot cost $14.49 each,
Cost-5200 cs (4 per cs) $301,392.00
Sales at Commissary- $436,800.00 (we bought for $21.00 May 2009)
Not bad. 45% markup

sunray's wench said...

@ 8.29 ~ your source for that info?

Anonymous said...

@sunray's wench--Dr. Murray VP of CMC put that out to UTMB staff last week. Not aware of his source.

Anonymous said...

Oh TDCJ medical is doing everything they can think of to discourage inmates. EX: Hubby had s sick call lay-in at 5 a.m. to get ibuprofen. He sat in the waiting room for 4 hours waiting for the nurse to get there. They turned off the AC in the waiting room and put in a fan to blow the hot air around. And they charged him 3 bucks for it.

He says he will go indigent before he allows them to take 100 dollars out of his account. I only put 50 $ on his books a month. How is that going to work? What if they don't have 100 dollars on their books, will they just take what they have until they get it all?

sunray's wench said...

@9.34 ~ read the text of the Bill. It says that if an inmate does not have the $100 in their account, then 50% of any future deposit will be taken until the $100 has been collected.

It also says that over-the-counter medication such as ibuprofen will be available through comissary.

PAPA said...

Punish the Family Unit more and more...they move the Inmates completely across the state from their Family Unit costing the family Big Bucks $$$ to go visit if they can go at all...TDCJ is supposed to be supportive of FAMILY to help the Inmate? Now charge the family for the cost of:
1.When the guards beat the Inmate down does that come out of the guards paycheck or the Victim's family's paycheck?
2.When another Inmate beats up the Inmate, does the prepetrator's family get to pay the cost, or the VICTIM's family paycheck have to pay
3.The Majority of the Inmates are free salve laborers working for nothing do they NOT have any benefits for being salve laborers
4.Send the illegals back to their own country because they don't get any help from their families and ride free on the Texas Taxpayers and Families of Inmates payroll
5.Lot of the medical cost could be cut by using preventive medical practices...instead the Inmates do not get proper treatment when a problem first starts;therefore, the prolong care creates major medical issues and cost.
6.The guards punish the Inmates when they do get medical care, especially like surgery they put them back in the fields working with stiches in them...they are such stupid is stupid does guards they have never figured out that their retaliation ends up costing more in medical care and that medical cost comes fromt he taxes that are withheld out of their paycheck...when will they ever figure this out...if they saved some of the cost of the damage they create then maybe they could get a pay raise
Just like the government, the middle class taxpayers carry the entire load, and now this same practice is being put into operation inside the prisons...

Anonymous said...

I'm surprised grits hasn't caught wind or wrote about the UTMB layoffs that are supposed to take place tomorrow...where's the info on that?!

Anonymous said...

So was this bill passed in the Senate or not?

Gritsforbreakfast said...

It passed in the special session.

Anonymous said...

So what you're saying is now my husband will have half of all the money I send him taken from his commissary account until the money equals 100 each year?

Anonymous said...

Too bad many CO's don't follow the rules. Most CO's, since most TDCJ Units are located in tiny backwoods towns, are backward a** hicks with an IQ that is borderline retarded . There are a few good ones, but the bad ones far outweigh the good ones.

Ft. Worth Realtor said...

Where can i get a copy of this healthcare tax on inmates. all of the details

Mark Angel said...

I agree with anonymous 6/22/2011 06:17:00 AM, plus I feel that if TDCJ wants to charge for medical then start paying for all that free labor it profits from. They're already posting notices to discourage inmates at the ROBERTSON UNIT. It's only a HOUSE BILL yet to become law with the TEXAS SENATE and as a former inmate myself I think that's downright chickenshit! MARQUITOS