County grapples with cost of inmate medical care

By ANDREW MCGINN
a.mcginn@beeherald.com

As the nation debates whether health care is a basic right, there’s still one way to guarantee free access to medical care.

Commit a crime.

Inmates remain the only class of people with a constitutional right to health care, as determined in a 1976 U.S. Supreme Court ruling that denial or delay of medical care while behind bars violates the Constitution’s Eighth Amendment — the amendment that prohibits “cruel and unusual punishments.”

Because Medicaid doesn’t pay for the medical care of inmates, those doctor and even dentist bills become the responsibility of the county.

That’s becoming painfully evident even in Greene County, where a facility as small as an eight-person jail can rack up the bills.

“The county’s stuck with the bills,” County Auditor Jane Heun said.

County supervisors on Monday paid a bill from the Greene County Medical Center in the amount of $7,738 for a single inmate’s care.

Sheriff Jack Williams said that expense — “extremely high” for one inmate’s care — will come out of his office’s “food and provisions” budgetary line item.

“It hurts a lot,” he said.

Citing privacy, Williams couldn’t disclose what the male inmate was treated for in January, but said it was a pre-existing condition “aggravated by being in jail.”

The inmate’s original bill was for closer to $10,000, Williams said.

“The hospital’s good at trying to get Medicaid to pay,” he said. “Sometimes they do and sometimes they don’t. This one they chose not to.”

That’s become even more difficult since Iowa’s privatization of Medicaid, Williams said.

Just like the cost of health care, the U.S. prison population has been on the increase as well.

Since the 1980s, the nation’s jail population has more than tripled — with serious ramifications for county personnel and coffers.

According to a report this year from the nonprofit, nonpartisan Prison Policy Initiative, one out of every three people behind bars is in a local jail.

Private insurance mostly pays for care, but most people dealt with by law enforcement don’t have insurance, according to Williams.

However, on the federal government’s HealthCare.gov, it explicitly says people in prison or jail are ineligible to buy private insurance through the Marketplace.

“As soon as you’re incarcerated, Medicaid stops,” Williams said.

Locally, the Greene County Jail can hold someone for up to one year.

“As soon as they get to jail,” Williams said, “they want treated for pretty much everything across the board.”

The county also pays for prescription drugs — something inmates have figured out, he said.

Williams estimates the typical inmate racks up a couple hundred dollars per month in medical care.

It also eats up manpower to regularly transport inmates back and forth to doctor visits, he said.

Williams has $44,000 budgeted in fiscal-year 2018 for “food and provisions.”

In fiscal-year 2017, Heun said, the sheriff’s office spent $44,459 on food and provisions.

Back in fiscal-year 2014, those costs ran as high as $49,000, she said.

The total budget for the sheriff’s office is just under $1.5 million.

The one inmate’s $7,738 bill is among the biggest Heun has seen in her 16 years as county auditor.

“I’ve asked repeatedly,” Heun said as to why Medicaid or insurance won’t pay for an inmate’s health care.

State Sen. Jerry Behn, R-Boone, said he’s seeking more information on why counties are stuck with inmate medical bills.

Behn said there was an attempt to fix the situation a couple of years ago, but the bill didn’t proceed.

“There are evidently issues with some federal requirements,” he said.