Pennsylvania lawmakers have taken the first step to end a policy that harms the health of incarcerated people. House Bill 1753, recently introduced in the General Assembly, would eliminate the $5 medical copay and other fees that serve as barriers to accessing health care behind bars.

Passing this bill would ensure access to health care in prison and promote public health.

Recognizing the harm that the copay can cause, the Department of Corrections suspended the $5 fee indefinitely in May. The department views the copay as a barrier that was jeopardizing efforts to control COVID-19 in prisons. Now, the legislature has an opportunity to permanently abolish a policy that formerly incarcerated people say has always obstructed access to medical care in prison.

Forced to choose between their health and other needs

John Mitchell remembers the “extreme pain” he felt when he got injured working his prison job one day. He had been lifting a heavy container while making “top pay”⁠—$0.42 an hour⁠—as a block worker.

"I got hurt on my job, and then when I went to medical, they charged me for that,” John says.

The $5 fee for the medical visit he needed would take 12 hours of work to pay off. But John points out that it could be worse⁠—if he were still making the starting prison wage of $0.19 an hour, it would have taken more than twice that long. And that was assuming he didn’t have to pay for medications and other treatments the doctor prescribed, which would each come with an additional $5 charge. ​​

"If you need an Ace bandage you're paying $5 for that. If you needed two different type of pills you’re paying for that. You know, you paid for everything,” John says.

The burden these costs placed on their meager earnings forced him and other people he knew to choose between their medical needs and other necessities like soap and deodorant, which they also had to pay for.

“You've got to choose, do I go to medical, because I really need to, or do I not go to medical and just tough it out,” John says. “There’s times I was sick and I just wouldn’t go.”

This time, he didn’t have a choice. It turned out the pain he felt was a hernia, and he would eventually need surgery.

Copays add to the financial burden on families

Michael Harper says he also saw how the fees deterred countless numbers of his peers from seeking medical treatment while he was incarcerated.

"I would witness a lot of people⁠—and I'm telling you, a lot⁠—refusing to go to medical because they didn't want to pay the copay,” Michael says. He was fortunate to have family support to help pay expenses his prison income couldn’t cover, or he might have found himself in that position, too.

Because incarcerated people don’t make sufficient income to pay for prison medical care themselves, the costs often fall upon their families. It adds to the hundreds of dollars a month many families pay on phone calls, prison visits, clothing, and other support for their incarcerated loved ones.

But many guys Michael knew in prison couldn’t count on any financial support from outside. He says it never made sense to him why incarcerated people should be required to pay for their own health care, especially without having the opportunity to earn enough to afford the cost.

“You are under state care and a ward of the state,” Michael says. “So why am I paying you for a copay?”

When copays force incarcerated people to forgo medical treatment, it creates complications not only for their own health, but for the prison community and public health at large. Minor health problems that aren’t caught early can grow into more serious conditions requiring more expensive treatment. When infectious diseases like COVID-19 go undetected and untreated, they can more easily spread to other people in custody and staff, and ultimately infect more people in the community.

The Prison Society calls for Pennsylvania state legislators to pass House Bill 1753 and permanently eliminate medical copays and fees that block access to health care in state prisons.

In addition, the Prison Society continues to call on all state and county officials to:

• Expand efforts to safely reduce the number of people in custody;
• Continue to offer COVID-19 vaccinations to all people in custody and staff in prisons and jails;
• Implement weekly, rapid testing of all staff that come into contact with people in custody until they are vaccinated;    
• Require that every county publicly report prison testing results and virus-related deaths in custody; and
• Test and quarantine every new person entering custody.

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