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Health care headache at county jails
Saturday, October 29, 2005
The skyrocketing cost of jail health care has become an open sore for counties nationwide, including Kent -- which spent more than $4.4 million for inmate care last year. Michigan lawmakers are trying to cauterize the wound with legislation that could get some inmates to pay for their own medical care. It's little more than a Band-Aid for soaring costs, but is worth a try.

A bill sponsored by Saginaw County Sen. Michael Goschka, R-Brant, relieves counties of making upfront payments for an inmate's care that might be covered by private insurance or Medicaid. Typical practice now is for counties to pay for the care and then seek reimbursement from an insurer or the government program that covers health costs for low-income families. Mr. Goschka's legislation makes counties the last -- not the first -- stop for payment of inmates' health costs. That seems reasonable. Hospitals and other care providers have systems in place to bill insurers and Medicare and Medicaid. They can do it more efficiently than county officials. The Senate passed the bill last week and sent it to the House. County officials are excited about the bill, but the jury is still out as to whether the change will be financial fruitful. County jails are not likely to be full of inmates with good jobs that provide great health benefits.

A survey of prisoners by intake nurses at the Kent County Jail found that fewer than 30 percent said they had health insurance. Even for those who do, trying to get insurance companies to pay for their medical care could be difficult. An analysis done by the Senate Fiscal Agency didn't find any insurance companies that maintained coverage once a client became incarcerated. Most policies had discontinuation clauses that sever coverage with arrest and detention. It's the same story for inmates eligible for federal Medicare or Medicaid coverage. Most no longer qualify for benefits while incarcerated.

The National Association of

Counties is trying to persuade Congress to allow Medicaid- and Medicare-eligible inmates to retain their coverage unless they are convicted. That is reasonable. People jailed and awaiting trial, but not yet convicted of anything, shouldn't lose their benefits. That scenario not only should apply to Medicaid and Medicare recipients, but people covered by private insurance as well. Conviction, not arrest and incarceration, ought to govern loss of health care coverage.

The present set-up and rising health care costs are driving some law enforcement officials to get creative to limit inmate medical expenses. Allegan County officials didn't charge an illegal immigrant for causing a fatal crash in 2000 until the suspect was released from the hospital nearly a year later. Had they arrested and charged the man sooner, the county would have been responsible for his medical bills. Ottawa County officials allowed a woman who had sex with a minor to remain free on bond until after she gave birth, avoiding the expense for her maternity care.

Inmate health care costs rose 42 percent nationwide last year to $3.7 billion, according to the American Correctional Association. A big reason is the growing number of inmates with mental illnesses and other diseases that require lots of medicines, such as AIDS. Approximately 54 percent of the 31,700 inmates booked into the Kent County Jail last year were on medicines.

The Goschka bill is not a remedy for the inmate health care headache, but might provide some relief. With medical costs continuing to escalate, finding a way to defray the expense is vital. But walking away from the responsibility to keep prisoners in good health is not an option. Inmates are serving time in jail, not a leper colony.