As you all have probably heard, there is a slight budget problem here in the city of Omaha.

With Omaha’s Mayor Suttle attempting to re-write the contracts signed in years gone by that detail medical care for retired city workers, the focus on making everyone pay their fair share has come to the fore. On broadcast news station message boards, Facebook and other social media, there has been a considerable call for people to “pay their fair share.”

I’m all in favor of being fair. Fair is good.

Unfortunately, it seems to me that the powers that be have skipped over a large segment of Omaha’s population when they looked for ways to level out our sinking budgets – our county inmates.

What happens now is that an experienced inmate comes into the jail and immediately fills out a kite to see a dentist, for free. Then the inmate usually fills out a kite saying their shoulder is hurting from when they were arrested in order to get a free 30-day prescription for Motrin. If the inmate has any phantom aches or pains, they write a kite to get on sick call to talk to a doctor, for free.

Right now, Douglas County does not charge incarcerated inmates for medical care in any way, shape or form. Inmates, including the ones who shoot your neighbors, kill your dogs, molest your children and run over people crossing the street, get all medical care provided to them absolutely free while they’re in the Douglas County jail.

But how can someone without a job reasonably be expected to pay a co-pay to see a doctor,” you ask? “That’s inhumane,” you scream!

Well, before we call the ACLU in to Douglas County to head off conversation on this topic, let’s look at how other jails run things. Do other jails and prisons charge for health care? Yes, absolutely. There are many, many more jails and prisons that charge a co-pay when an inmate sees a doctor than those jails and prisons that do not. Take a look at Polk County, Nebraska as an example. This is from their inmate handbook:

Polk County Health Care Fees
A co-pay fee will be charged to inmates who sign up for sick call and are seen by a physician or physician’s assistant, or receive a prescribed medication. Federal inmates will be billed for co-pays after 30 days in custody. Medical care is provided to all inmates regardless of finances.
The co-pay fee schedule is as follows:

Sick call – $5.00
Physician, Physician’s assistant, Psychiatrist visit -$10.00
Dental Visit -$10.00
Prescription Medications -$5.00
Mental Health Visit – $5.00

Note: Due to the rising cost in the medical field, the co-pay fees may change. If this change occurs, a notice will be placed in the housing units.

It is a federal rule that inmates incarcerated in United States jails must have access to health care despite their finances. That means an inmate without the money on his or her inmate account to cover a co-pay or a prescription bill will never be charged. If Douglas County started charging their inmates co-pays and prescription fees, indigent inmates in Douglas County would continue to receive their medical treatment and drug prescriptions absolutely free.

The only people that this would affect are the inmates who have money on their inmate accounts. And there are a lot of inmates with money on their accounts.

With that money, they’d be forced to make a series of decisions:

Do I want to go see the dentist, or do I want to buy 4 candy bars and a bag of chips?
Do I want to pay $5 for that 30-day Motrin prescription or do I want to buy some Tylenol off commissary?
Do I want to go see the doctor for a sprained ankle I twisted while playing basketball in my shower shoes, or would I rather save that money for something else?

In addition to teaching inmates to make good financial decisions, charging inmates co-pays would dramatically reduce the amount of frivolous kite-writing to the Douglas County medical department for every ache and pain. All those kites have to be answered and returned. That’s a lot of man-hours wasted every day.

Now, instituting a program to charge inmates for medical visits and prescription drugs may not be the answer to the area’s budget problems – but it might be a step in the right direction. It’s something that should at least be on the table for discussion.

Now, so you don’t think I’m selling you sunshine and roses, there are some facilities who have reported problems with co-pay systems for inmates. For example:

The Pinellas County Jail will no longer charge an $8 co-payment to inmates seeking medical care, forfeiting an estimated $50,000 in annual revenue from a policy that jail officials said created more problems than profit.

The jail used co-pays to help offset millions of dollars in medical bills and discourage requests for unnecessary treatments or bogus ailments. Most medical insurance does the same thing.

In 1995, when the co-pays began, jail officials told the Times that the charges had cut demand for care in half, an early sign that they were clearing waiting rooms of all but those with real medical need.

But in the years since, said Pinellas County Sheriff Jim Coats, the co-pays have bred hostility among inmates and bogged down staff with paperwork, making the tens of thousands in lost cash “not even worth it.”

“The administrative reviewing and tracking of all that cost us more than we make,” said Sheriff’s Office Chief Deputy Bob Gualtieri. “The bang wasn’t worth the buck.”

After further review of the information available, I have yet to see this example as anything other than an isolated case. And who knows? Maybe there were extenuating factors involved in the Pinellas County system’s failure to make it work. Maybe someone was in love with paperwork for paperwork’s sake. Maybe someone couldn’t figure out a good way to automate or computerize the process and eliminate the wasted time and frustration involved when the people involved in running a system don’t like the system. Who knows?

What we do know is that there are thousands of jails and prisons nationwide that do have a copay system in place, one that works.

So why don’t we?

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