United States: prisons shouldn’t be charging medical co-pays, especially during a pandemic

Despite a record number of new COVID-19 cases in prisons this month, some state departments of correction are already starting to roll back necessary suspensions of medical co-pays. Prior to the pandemic, most prison systems charged incarcerated people between $2 and $5 for each medical appointment — a fee that can make attaining medical care burdensome or impossible. In March, we found that many states had relaxed these policies in response to the pandemic, either suspending all medical co-pays, or suspending those for respiratory or flu-like symptoms. But in a follow-up survey of medical co-pay policies, we found that since March, three states have made their policies more restrictive in the middle of the pandemic.

Arkansas, Idaho, and Minnesota had previously suspended all co-pays as of March, but have since reinstated co-pays for non-flu-like symptoms. They are now among 29 states that currently suspend co-pays only for visits involving respiratory, flu-related, or COVID-19 symptoms — a policy that discourages many from seeking treatment. Even worse, Nevada has continued to charge co-pays throughout the pandemic, regardless of symptoms.

Meanwhile, three states have improved their policies since March: New Jersey has suspended all medical co-pays, and Delaware and Hawaii suspended co-pays for those with flu-like symptoms.

Before the pandemic prompted these suspensions, all but 11 states charged medical co-pays. While a $2 to $5 co-pay may not seem like much to a “free world” worker, unconscionably low wages in prisons make even the lower medical co-pays entirely too expensive. Because incarcerated people typically earn 14 to 63 cents per hour, these charges are the equivalent of charging a free-world worker $200 or $500 for a medical visit.

Currently, most states are suspending co-pays for flu-like or respiratory symptoms. But this is not enough to ensure that people are comfortable seeking treatment, and thereby preventing the spread of the virus. As we’ve seen over the course of the pandemic, not all COVID-19 symptoms fall within these vague categories – and many people don’t display symptoms at all. And some states, such as Indiana, have implemented policies that charge co-pays to those who “disingenuously” report symptoms. Policies like these could lead people to hold off on seeking care until their symptoms become more severe. What’s more, it’s likely harder than ever for many incarcerated people to afford medical copays, due to possible loss of paid work for themselves and their loved ones.

Prisons should instead enact policies that mirror the outside world, where people are encouraged to get tested often and carefully monitor their symptoms to prevent outbreaks. Suspending medical co-pays for everyone for the duration of the pandemic – or better yet, beyond the pandemic, as 11 states and D.C. have already done – is a necessary step departments of corrections should take to attempt to stop the spread of COVID-19 in prisons.