The ‘Black Market’ in Prison Health Care

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In 2011, the Texas Department of Criminal Justice (TDCJ) came up with a way to reduce the costs of covering health care for the incarcerated.

All prisoners, unless they were indigent, were required to provide a $100 co-payment that would cover all visits to prison health services during a year. Emergency care and certain other services were excluded from the co-payment requirement.

Did it work?   Here’s one answer: In 2017, TDCJ requested $247 million from the state just to maintain the costs of meeting the medical expenses of individuals incarcerated in the system at current existing levels.

Texas isn’t the only state that uses prisoner copayments and related fees to address the rising costs of correctional health care.  Some 42 states have adopted some form of co-pay for non-emergency, patient-initiated visits with jail or prison medical staff, according to a report by the Prison Policy Initiative.

And their experiences have mostly been just as disappointing as Texas.

Michigan, for example, collected less than $200,000 on such fees in 2014—making hardly a dent in the state’s $300 million prison health care budget.

But the real issue about co-payments has mostly been ignored. The fact is, the $100 co-payment is one of the reasons why the Texas prison health system is in such deep trouble.

It created a “black market” in health services that ended up inflating prison health costs while doing little to improve a system that provides at best only perfunctory medical care.

As a long-serving resident of the largest prison system of the country, I’ve had a front-row seat on the problem—and I’ve watched it develop into a massive scam.

Here’s how it works with two offenders I’ll call “James Doe” and “John Doe.”

James Doe refuses to pay the $100 copayment and avoids visiting the prison doctor. John Doe is indigent so he can see the doctor without charge.  The actual cost of medical care for each inmate ranges between $30,000 and $35,000 annually. But James and John agree to conspire together.

John makes bogus medical appointments to obtain the medication or equipment that James needs, in return for cookies, coffee or other low-price commissary items. But John also sees a business opportunity, and he begins making bogus trips to hospitals utilized by the system, just to obtain the additional medications or material that he can sell clandestinely to other “James Does” who similarly resist the co-payment.

The system ends up underwriting this black-market activity while its costs skyrocket.

How widespread is the practice? Do the math.

Out of over 140,000 offenders in TDCJ, nearly 50 percent are indigent.  Out of that 50 percent, I estimate that more than 50,000 are actively participating in the thriving black market that the $100 co-payment has created.

When you combine this with prison health care issues that have already been raised by the media, such as the aging prison population, it’s easy to see why Texas’ prison health care costs are a financial nightmare.

Is it happening elsewhere? I can’t answer that.

But while state prison authorities struggle with legislatures to figure out how to pay their rising health bills, perhaps it’s time to rethink the principle of co-pay.

Jeremy Busby has served more than 20 years of a 75-year sentence for murder. Currently housed in the Mark Stiles Unit, a maximum security facility in Beaumont, Texas, he is seeking exoneration for what he maintains is a wrongful conviction at age 21. Meanwhile, he has earned a graduate degree from the University of Houston-Clear Lake and is a former staff writer for TCJ’s prison newspaper. Readers’ comments are welcome.

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