Roy Exum: An Idea For Erlanger

Tuesday, April 8, 2014 - by Roy Exum
Roy Exum
Roy Exum

Cash-strapped public hospitals, such as Chattanooga’s Erlanger Hospital, are saddled with providing many millions of dollars in uncompensated health care for prisoners in city and county jails. Last year Erlanger – and remember it is the taxpayers who own the hospital -- spent over $5 million on prisoners in our region and didn’t get a dime in return. Let’s not complain – that is what a civil society must do.

But let’s be slick at the same time. All across the country counties such as our Hamilton County are finding they can divert some of the staggering costs to the federal government. Instead of relying on an outdated allocation that makes Erlanger the lowest-funded public hospital for the services it delivers in the entire United States, we can rightfully pass some expenses on to our fellow taxpayers in all of those same 50 states.

Under the new rules of Obamacare, counties in at least a dozen states have already figured a way to begin enrolling inmates into plans made possible by the Affordable Care Act. When it is done properly, the move can and will transfer between 30 and 50 percent of health care cost for our prisoners to the federal government and the bonus is that every prisoner, upon release, will have health insurance coverage for their families.

As far-fetched as that might sound, the Obama administration has promised from the start that those with pre-existing conditions or who cannot afford insurance (some due to poverty) may be able to get covered under the Affordable Care Act. It’s true that the ACA specifically prohibits full-time prisoners serving sentences from participating in Obamacare but – wait -- cities around the country have found a wonderful loophole and are scrambling to sign up applicants on the very day they are booked in jail.

Here is how it works: While “incarcerated inmates” are prohibited from joining Obamacare – read this carefully -- those who are “incarcerated pending the deposition of charges” (meaning those who can’t make bail or who are being held for other reasons before their trial) can indeed enroll before they are finally sentenced. They are innocent until proven guilty, right? And it is estimated that our nation’s city and county prisons are holding prisoners where at least two-thirds of the inmates are still awaiting trial.

It has also been determined that approximately 70 percent of the 10 million people who are released from prison each year do not have health insurance. But if a prisoner is signed up to the ACA prior to sentencing and then happens to spend 24 hours or longer in a hospital, he or she is no longer considered a prisoner (they are instead “hospitalized,” that is the legal view) and Medicaid will pay 100 percent of the costs.

This is so easy. In Kentucky, Louisville Metro Corrections houses approximately 2,000 prisoners and health costs are roughly $9 million a year. The high-ticket items are chronic disease, cancer, heart disease, substance abuse and mental illness. Female inmates who give birth while incarcerated are a huge expense. But emergency room visits, occasional surgeries, and the fact prisoners have other health issues are well-known. If they can save 30 percent, that’s $3 million!

Fred Osher, the medical director of the non-partisan Council of State Governments, told a Louisville writer not long ago that one-third of people going in or out of prisoners could qualify for Medicaid and about another 24 percent could qualify for subsidized health coverage. That’s why prison officials in Colorado, Illinois, Oregon and a growing number of other states are attempting to switch the health costs to the federal government as fast as is humanly possible.

Mark Bolton, the director at Louisville Metro Corrections, predicted some citizens would be irked a prisoner can qualify for Medicaid -- while they cannot -- but pointed out, “The taxpayers are paying for these prisoners’ medical care already.”

Health care costs for prisoners in the state of Kentucky have increased 134 percent over eight years. The department of corrections believes it can transfer costs through the Affordable Care Act and state heath exchanges that would result in a saving of over $5 million a year.

Further, since prisoners will have insurance when they are released, they can easily continue to deal with chronic illnesses. The treatments for such diseases as diabetes, cancer and heart issues will go on, as will medicines for mental illness and substance abuse that often lead back to prison.

According to reports, San Francisco Sheriff Ross Mirkarimi is attempting to sign up prisoners the day they are first booked and fingerprinted. He has a model that shows San Francisco will save $2,500 on every prisoner. In Portland the Multnomah County sheriff is eyeing a savings this year of $1 million because the Oregon officials – get this -- have already enrolled over 700 prisoners in Obamacare.

Cook County, home of the largest single-site jail in the country, has initiated over 15,000 applications in Chicago alone. In Iowa, where 4,000 prisoners are released every year, official have embraced the goal of enrolling every one of them. It is a win-win situation. We need to start this today.

Here’s a splendid reason. Between six-to-ten percent of female inmates are pregnant when they are booked. Sign ‘em up before they are sentenced. Why? A normal delivery costs roughly $10,000 but, if there are complications, the cost can rise into hundreds of thousands of dollars. Because most deliveries take more than 24 hours, Medicaid will pay 100 percent of costs for a “patient” rather than the county having to cover it for a “prisoner.”

Under the old Medicaid plan, the federal agency would pick up 58 percent of medical costs while the hospital would be forced to shoulder the difference. Under the Affordable Care Act, the federal government will pay 100 percent the first three years before the payback drops to 90 percent.

I’m telling you, this is low-hanging fruit. And it’s ripe for picking.

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