Hot Take: Health Care Copays are Placing Our Inmates at Risk

Hebron Kelecha – Class of 2021

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Imagine you work in the kitchen of a correctional facility and your copay for a doctors’ visit costs $5. However, you make a whopping 33 cents an hour.

That is the reality faced by many who are incarcerated in prisons throughout the United States. It is not surprising that most of our prison population is poor when they enter the prison system. Couple this with jobs that pay less than a dollar an hour and fees for accessing health care, and we are laying the foundation for negative health outcomes.

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According to the Brennan Center for Justice, currently 39 states authorize the collection of fees from inmates for access to non-emergent medical services. These fees often range from $5 to $20 per visit. This can be significant for most prisoners as it forces them to pay a minimum of one-week’s salary in order to visit a physician.

This was not always the case. The expansion of our jail and prison populations through implementation of mandatory minimums and three strike laws caused the prison population to reach an astounding 2.3 million persons behind bars.

The 1976 Supreme Court case Estelle v. Gamble requires correctional facilities to provide adequate medical care to prisoners. Not doing so results in a violation of the Constitution’s Eighth Amendment against cruel and unusual punishment.

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The growing prison population coupled with the requirement to provide medical services to inmates has made medical care an expensive feat for the correctional system. To offset costs, states charge inmates small fees. According to a study done by the Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, prison health care spending alone reached a staggering $8.2 billion in 2009.

These costs are not only due to the rising number of incarcerated people; the age and health demographic of this population as well. The number of adults over age 50 in prison is rising, and incarcerated populations have higher rates of chronic diseases, communicable diseases, and mental health problems. This necessitates a strong health care system that is easily accessible and affordable.

In addition, there are consequences for avoiding care, an inmate’s condition may worsen and require more emergent care or lead to the spread of communicable diseases throughout the facility. The result being more expensive than preventative care.

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Unfortunately, despite the Supreme Court ruling, many inmates who suffer from physical and mental problems are living without health care. A 2009 study found that 13.9% of federal inmates, 20.1% of state inmates, and 68.4% of local jail inmates had received no medical examination since the start of their incarceration, and many lacked adequate medication reconciliation upon arrest.

Despite these growing concerns, numerous states claim that copays are necessary to discourage unnecessary use of medical services and help off-set high costs. In addition, many states that have implemented copays do not charge inmates if they are unable to pay. Regardless, these copays continue to be an additional barrier for many individuals, particularly those dependent on family or relying on very minimal wages.

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It’s no secret that providing medical care to high-risk groups such as prison populations is a significant expenditure. However, in a system that is already punitive, copays are an additional barrier to accessing care for this population. It forces many inmates to choose where to spend the minimal income they have, and it can deter inmates from seeking necessary and potentially life-saving care.

Consider yourself in the shoes of a diabetic inmate making 33 cents an hour. You have a small foot wound. Do you use half of your wages to address this wound or save the money to call your mother for the first time in months?