Guest Blog: The Logic of the $100 Offender Copay and the Unintended Consequences

By Jennifer Erschabek Austin Chapter Chair, Texas Inmate Families Association (TIFA) Last session, a bill passed that requires the Texas Department of Criminal Justice (TDCJ) offenders to pay a $100 annual health care fee when initiating a medical visit. The new law also allows TDCJ to supply more over-the-counter (OTC) medications in the prison commissaries. This was passed as a way for the state to recover some of the medical costs of providing healthcare to inmates.  Besides the obvious concern that families and friends of inmates (when they can afford it) are bearing an additional cost when it is the state’s responsibility to provide care for those the state chooses to incarcerate, this new practice might not even be that effective at saving taxpayer dollars. The state estimates that this prisoner co-pay will generate $10-$13 million over the next biennium.  But, we wonder how realistic this number really is.  Indigent prisoners (40-50 percent of the offender population) and those with chronic conditions are waived from the fee. This raises another concern about whether indigent inmates are correctly identified for exemption. Younger and healthier inmates will avoid using the medical system so they don’t have to pay the fee. But, to us, it isn’t only about the money for which our loved ones receive low quality health care.  The new law allows for indigent inmates to receive free clinic visits and also free OTC medications.  According to our family members within TDCJ, this has resulted in a black market for medications, where indigent inmates are trading their OTCs for commissary goods. In many cases, offenders who do have money on their accounts are refusing to go to the clinic, instead self-diagnosing and ‘trading’ for medications to avoid the $100 charge for a medical visit. The medical co-pay also impacts the health of the entire unit, offenders and guards. When offenders are not treated for contagious diseases such as scabies, mumps and staph infections, nobody wins.  This is a real threat to public health – in and out of prison.  Remember, many inmates are locked up for a short period of time, and then return to society. It benefits all of us to ensure that they return to society free of communicable illnesses. There has been one good result because of the co-pay.  Now that more OTC medications are available to offenders through the commissary there are fewer medical visits.  But, they could have done this before - you really don’t need to see a nurse or doctor just to get Lotrimin or Benadryl. Most important: It is the state’s responsibility to cover the medical costs of individuals who we choose to incarcerate.  TIFA will continue to work to lower this unjust and unhelpful copay. Find out more about TIFA, and the work that we do.