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Prisoner Co-payments for Health Care Services Eliminated in California

by Chad Marks

In 1994, California lawmakers passed a bill that charged prisoners a $3.00 fee when they visited the infirmary for medical or dental care in city and county jails.

Twenty-five years later, on September 10, 2019, the California senate voted in favor of Assembly Bill 45, which eliminates co-pays for medical and dental services in local jails and state prisons. Governor Gavin Newsom signed AB 45 into law the following month. The California Department of Corrections and Rehabilitation (CDCR) had already voluntarily eliminated $5.00 co-pays for state prisoners, in March 2019. [See: PLN, Nov. 2019, p.16].

The CDCR found there was minimal fiscal benefit to the co-pays and such payments may cause prisoners not to seek health care. With those hindrances, early detection and intervention of injuries and illnesses may become exacerbated, which could end up costing more in the long term.

Taylor Lytle, a former prisoner and community organizer with the California Coalition for Women Prisoners, said, “I made eight cents an hour at my kitchen job but was still required to pay a fee to the doctor.” She noted that when she was ill she had a choice – either pay to obtain medical care or spend her money on soap. A lot of prisoners who earn paltry wages will choose soap.

Improvements in health care benefit not only prisoners but also staff and taxpayers. In 2003, the Centers for Disease Control and Prevention found that co-pays were one of the factors contributing to MRSA outbreaks among prisoners. Rather than paying the co-pay, prisoners who felt ill tried to tough it out. Such actions put others, including staff, at risk of communicable diseases. And as illnesses get worse, more expensive treatment is needed.

“People who are most likely to be incarcerated are also the most likely to have chronic healthcare issues,” noted Eric Henderson, the policy director of Initiate Justice, based in Los Angeles. “By imposing a fee to access care, we are expecting currently incarcerated people to triage themselves. Ultimately, this exacerbates existing conditions and puts their health and the health of others at risk.”

Most prisoners earn pennies per hour. When they have to spend $3.00 or $5.00 to go to the clinic, that takes a significant amount of their meager pay. Abolishing co-pays in jails and prisons is a smart move, and other states should follow California’s lead. Some already have, including Missouri, Montana, New Mexico, New York, Nebraska, Oregon and Wyoming, which have eliminated medical co-pays for prisoners.

“Our prison system is based off of exploitation of labor...,” said California Assemblyman Mark Stone, who introduced AB 45. “An incarcerated individual will have to work over 60 hours while making eight cents an hour to be able to afford a medical visit.”

“Although the copayment program was authorized with the intention of reducing the financial and administrative burden of prison health care, there is no data demonstrating that the program is cost-effective,” the text of AB 45 states. “Analyses of copayment programs in other states have found that the administration of copayment programs in correctional institutions often costs more than the revenue collected from incarcerated people.”

The legislation went into effect in California at the beginning of 2020. 



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