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Charging Inmates More for Their Health Care Really Not Working Out For Texas

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Because of a new law passed in the last legislative session, Texas Department of Criminal Justice inmates are now faced with a choice when they need to see a doctor: pay a yearly $100 fee, or don't go in for treatment at all. As the Texas Tribune reports today, many of them are choosing the latter.

The law was House Bill 26 , sponsored by Representative Jerry Madden, a Republican from Plano. It required a $100 annual fee for prisoners who use any medical services; inmates who were unable to pay would have 50 percent of the money deposited into their trust funds by their family and friends taken out until the fee is covered. Indigent inmates -- those with $5 or less in their accounts -- wouldn't have any money taken from their trust funds. The idea, Madden said at the time, was to try to recoup some of the roughly $950 million that taxpayers put towards inmate medical care every two years.

The new fee was supposed to raise $9.9 million over 2012 and 2013, including $5.7 million this year. Instead, it's raised less than half of that so far, about $2.5 million. In contrast, the $3 copay that inmates previously paid per visit generated around $500,000 a year.

Critics of the law warn that prisoners who forgo medical care could develop serious or contagious illnesses that will eventually cost the state much more.

"My big question is whether that copay is really saving any money," attorney Michelle Smith told the Trib. "Because more serious complaints that develop from lack of early detection end up costing more in the long run." An inmate client of Smith's recently missed a court date when he became ill with what he thought was the flu. He decided not to see a doctor because of the cost and ultimately developed pneumonia.

It's not as though Texas inmates are receiving particularly plush medical attention; in the last legislative session, lawmakers also cut around $120 million from prison healthcare, forcing providers to cut clinic hours and reduce vaccinations. Texas spends an average of $9.88 per inmate per day, according to the Texas Civil Rights Project. California, which pays about $28 an inmate, had its prison system declared unconstitutional last year and was ordered to release 40,000 inmates.

Even Madden, who authored the bill, concedes that the fee structure may need to be tweaked, although he still defends the law's original intent. "I believe it was the right thing to do at the time," he told the Tribune. "I still think it's a reasonable thing to do." And fixing the fee structure likely won't be Madden's problem anyway; he announced last year that he wouldn't run for reelection. His term ends in January.

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