Update

Dear Prison Society Supporters,

A groundbreaking study in the Journal of the American Medical Association confirms what incarcerated people have been reporting for years – that medical copays stop them from getting essential health care behind bars. 

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These findings further underscore the need to eliminate harmful prison medical copays.

Medical copays, or fees for accessing health care, are imposed in federal prisons and 40 state-prison systems. Pennsylvania state prisons charge $5 for a medical visit. Most county jails in the state also charge a copay, which ranges from about $3 to $5 to see a nurse and $5 to $10 to see a doctor. While the fees may seem small, they are often prohibitive for incarcerated people, who are disproportionately from impoverished communities and make meager wages at prison jobs, if they have any income at all. In Pennsylvania state prisons, wages range from $0.23 to $0.50 an hour for most jobs.

The new study, published in JAMA Internal Medicine, examined medical copay policies and prison wage data and compared health care access among incarcerated people who did not have to pay a copay, those who had copays that cost less than one week’s average wages, and those who had copays greater than one week’s wages. The researchers found that the percentage who had never received care for a chronic health condition while incarcerated was 9.4% for the group with no copay and 16.1% for those with copays that cost more than one week’s wages. That means that about 70% more incarcerated people with a chronic health condition did not receive treatment for their condition in prisons with high copays.

“The finding that co-payments in carceral settings were associated with worse access to care is novel, troubling, and unsurprising,” the researchers wrote, noting that the fees have a similar effect on health care access outside of prisons as well. 

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Chronic illness is becoming more prevalent in prisons

The study also looked at trends in the physical and mental health of people incarcerated in state and federal prisons between 2004 to 2016, the most recent year for which the national health data is available. The prevalence of chronic health conditions increased 10%, and the number of incarcerated people reporting three or more chronic conditions increased by nearly one-third. The deterioration of mental health was even more precipitous. Nearly twice as many incarcerated people reported having a chronic mental health condition, and the number reporting any mental health diagnosis increased 64%.

Despite the worsening mental and physical health of incarcerated people, a startling number have never received care in prison. Overall in 2016, about one out of seven people in state and federal prisons with at least one chronic condition reported not having been seen by a health care provider since they were incarcerated. Among those with a chronic mental health condition, one-third had not received any treatment.

In an editorial accompanying the study in JAMA Internal Medicine, physicians from the Yale School of Medicine argued that the study’s findings demand a response from policymakers. 

“Mass incarceration is a driver of health inequities, and charging for needed care harms both individuals and their families,” they wrote. “To meet the ethical obligation to provide needed health care access, the imposition of co-payments should be eliminated across all correctional systems.”

The Prison Society wholeheartedly agrees. That’s why we are calling on all state and county officials to permanently eliminate all medical copays in prisons and jails. At the state level, we urge elected representatives to pass legislation ending the $5 copay in state prisons.

Want to know if your county charges a copay? Visit our interactive map to find out: https://www.prisonsociety.org/map