How Medical Copays Haunt Prisoners and Their Loved Ones

January 17, 2017
VICE

In the Texas prison system, illness is just another way for the state to profit on the back of inmates.

It's early on a weekday morning and Kyle Walker is thinking about what she has to do to keep her incarcerated boyfriend alive. At over six feet tall, the energetic 41-year-old stands out from the relatively somber rush hour crowd making their way to the office buildings of downtown Austin, Texas. She's on her way to work as a legal assistant, the job that supports her two kids and her boyfriend, who despite being in the custody of the Texas Department of Criminal Justice still needs a constant stream of help just to have the most basic necessities behind bars. 

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Walker's boyfriend* has been labeled as a sex offender since he was 17, after he slept with his then-girlfriend, who was 13 at the time. Upon finishing a seven-year term in the Barry B. Telford Unit, a prison in New Boston, Texas, he struggled to find a home because of his sex offender status. When police came by her home acting on a tip that there were drugs on location in early 2015, Walker says, they arrested and charged her boyfriend with failing to register his residence, a violation of probation. Now he's back at the Telford Unit, the same prison in which he spent much of his youth. Despite making parole last summer, he's been unable to find a legal place to live, a condition of his release. And until Walker and her boyfriend sort that out, he needs to cope with the Texas prison system, where inmates supplement their meager provisions with food and supplies bought by their families on the outside. 

More than anything else, though, it's health care that comes at a steep price.

After a 2011 Texas law raised the copay for medical care from $3 for each visit to a $100 annual flat fee, families of the incarcerated have scrambled to find a way to pay the difference. If a prisoner is considered indigent, meaning they don't have any money in their "trust fund"—the account that's used to pay for items like food and toilet paper—then they don't have to pay the $100 to receive health care. But once any money is deposited into the trust fund, half of it is docked to go towards the outstanding copay until the full amount is paid off. For Walker, that means any money she places into her boyfriend's account would go to pay off his debt for the health care he's already received, which includes care for managing his schizophrenia, desperately needed dental work, and further treatment for mental health issues. 

"I can only afford to spend $30 to $40 every couple of weeks to support him, and even to just put the money in his trust fund, there's a fee for that transaction," Walker explains. "So for them to deduct half of the money for services he's already received—it defeats the purpose of me even sending him money."

Families and significant others like Walker have found themselves shouldering a growing financial burden as prison systems across America look to raise revenue by charging inmates for necessities like clothing, food, toilet paper, and even the prison cell they're being kept in. Right now, at least 35 states charge their prisoners for health care in some way or other, with some county jails going so far as to pursue civil actions against prisoners after they're released in hopes of recouping health care costs. But Texas has the highest state prison population in the country, with an average of over 150,000 people sitting in its cells at any one time. And like many things in Texas, the state's prison medical copay is easily the largest in America

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But the fact is that in Texas prisons, commissary—and the funds sent by families to ensure access to it—plays a key role in ensuring the safety and health of prisoners. Jennifer Erschabek has spent years advocating on behalf of the families of inmates as executive director of the Texas Inmate Families Association after her own son was incarcerated. Her son developed serious rashes on his hands and arms after working in a metal shop in incredibly hot conditions. Erschabek was able to buy for her son the anti-fungal medication to keep him from developing a serious medical problem, but others aren't so lucky as to have someone on the outside looking out for them. Scabies, skin infections, chicken pox, norovirus and other easily treated conditions confront prisoners, who face a constant struggle to maintain their health. 

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And even when prisoners see a doctor, either by claiming indigence or paying the copay, there's still a serious gap between what prisoners receive and the healthcare people get in the outside world. Jorge Renaud spent 27 years in the Texas prison system and is now an organizer at Grassroots Leadership, a national organization that aims to take profit out of the prison industry. For the amount of agricultural and physical labor that prisoners have to do, Renaud says, he witnessed indifference on the part of some authorities to physical pain. 

"I didn't have a really good medical check up the entire time I was there," Renaud tells me. "The medical care is atrocious, and every individual who has been incarcerated could give you a story about it."

For the past several years, the state has slashed millions from the budget for medical care, provided for most prisons by the University of Texas Medical Branch (UTMB), which runs a prison hospital in Galveston. As the age of prisoners continues to rise, along with the cost of care, UTMB has relied on telemedicine to make up the difference, where doctors can videoconference with prisoners instead of being on site. Dr. Owen Murray, the vice president of correctional managed care at UTMB, has watched as the population in the prison shifted considerably—there are now 27,000 inmates over the age of 50. With costs running so high, and the governor looking to cut the overall prison budget by as much as $250 million, Murray doesn't see the money generated by the copay as making much of a difference in the larger picture. People aren't paying, but the state continues to need to provide tremendous amounts of money for care.