Giving Compass' Take:
- Tiana Herring explains that in order to improve public health we must permanently end prison medical copays.
- How can you support shifts to improve prison health and reduce costs for incarcerated people?
- Read about the harms of prison poverty.
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In 2017, our analysis of medical copays in prisons across the country brought to light the common but utterly backwards practice of charging incarcerated people unaffordable fees for their health care. At that time, only eight states did not charge medical copays: Missouri, Montana, Nebraska, New Mexico, New York, Oregon, Vermont, and Wyoming. While several other states have since added themselves to this list, the vast majority have still not eliminated medical copays. With a new legislative session starting in many states, we reviewed each state’s policy — and any temporary changes they’ve made in response to the COVID-19 crisis — to identify places where repealing these fees should be on the agenda. (Looking for your state’s policies? See the appendix tables.)
Since 2017, two additional prison systems — California and Illinois — have eliminated medical copays, and, for the last two years, Virginia has suspended medical copays as part of a pilot program. Texas reduced its exorbitant $100 yearly health care fee to a less atrocious, but still out-of-reach, $13.55 per-visit fee. Idaho also reduced its medical copays in prison from $5 to $3 in 2018.
Even a $3 copay, though, is unaffordable for most incarcerated people, given the obscenely low wages that incarcerated people earn. For people earning 14 to 63 cents an hour in prison (and many earning nothing at all for their work), a typical $2-5 copay is the equivalent of charging a free-world worker $200 or $500 for a medical visit.
Unaffordable copays in prisons and jails have two inevitable and dangerous consequences. First, when sick people avoid the doctor, disease is more likely to spread to others in the facility and into the community, when people are released before being treated or when diseases are carried by correctional staff back to their homes. Second, illnesses are likely to worsen as long as people avoid the doctor, which means more aggressive (and expensive) treatment when they can no longer go without it. Medical copays encourage a dangerous waiting game for incarcerated people, correctional agencies, and the public, with little payoff in terms of offsetting medical costs and reducing “unnecessary” office visits. In fact, when evaluating the costs versus benefits of charging copays, the Oregon Department of Corrections concluded, “copay systems do not seem to lower overall health care costs,” and “triage on a case-by-case basis is more cost effective than implementing system-wide copayment plans.”
In the face of COVID-19, we’ve found that many prison systems relaxed their medical copay policies to avoid disincentivizing people in prison from seeking necessary medical care. Before these changes, medical copays in prisons typically ranged from $2 to $5. Twenty-eight states modified their policies during the first few months of the pandemic, and, ultimately, all but one state — Nevada — temporarily changed their policies. Of the states that do charge medical copays as a matter of policy, only 10 completely suspended these fees at some point in the pandemic. The federal Bureau of Prisons, on the other hand, did not modify their copay policy until March 2021, and only suspended copays for COVID-19 related care for three months before the waiver expired.
Most states that have modified their copay policies during the pandemic only suspended copays for respiratory, flu-related, or COVID-19 symptoms. But these limitations ignore the facts that not all COVID-19 symptoms fall within these vague categories, and many people don’t display symptoms at all.
As states stop publishing data about COVID-19 in prisons and start rolling back basic policies that do the bare minimum to protect incarcerated people, it’s important to remember that the pandemic is still ongoing and cases, hospitalizations, and deaths continue to rise.
Read the full article about eliminating prison medical copays by Tiana Herring at Prison Policy Initiative.