November 19, 2020

Warren, Pressley, Haaland Lead Bicameral Group of Lawmakers Requesting Information on Medical Copays in Prisons and Their Impact on the Spread of COVID-19

On March 30th, BOP waived copay requirements to make health care visits and treatment more accessible, but that waiver expired on October 1, 2020 and should be renewed as COVID-19 continues to spread; Lawmakers press DOJ and BOP on its shifting policies in response to mass outbreaks of COVID-19 among incarcerated individuals

Text of Letter (PDF)

Washington, DC - United States Senator Elizabeth Warren (D-Mass.), Congresswoman Ayanna Pressley (D-Mass.), and Congresswoman Deb Haaland (D-N.M.), along with Senators Richard Blumenthal (D-Conn.), Cory Booker (D-N.J.), Tammy Duckworth (D-Ill.), Dick Durbin (D-Ill.), Mazie K. Hirono (D-Hawaii), Edward J. Markey (D-Mass.), Bernie Sanders (I-Vt.), Tina Smith (D-Minn.), Chris Van Hollen (D-Md.), Representatives Eleanor Holmes Norton (D-D.C.), Jahana Hayes (D-Conn.), and André Carson (D-Ind.), sent a letter to the Department of Justice (DOJ) and the Federal Bureau of Prisons (BOP) seeking information about the status of medical copays in correctional facilities during the COVID-19 pandemic. On March 30, 2020, after 29 of the top 40 early COVID-19 hotspots were identified as originating in prisons or jails, the BOP issued a waiver on copay requirements for requested health care visits to make treatment and patient care more accessible. That waiver expired on October 1, 2020, and, as COVID-19 continues to spread throughout the nation and in jails and prisons -- where more than 252,000 cases have been reported -- it remains unclear whether the BOP has or will extend that waiver.

In federal and most state correctional facilities, incarcerated people must pay medical copays for physician visits, medications, dental treatment, and other health services. These fees are intended to help reimburse federal, state, and county governments for the high cost of medical care among this population; however, they are often exorbitant compared to the average incarcerated person's salary. Incarcerated people typically earn 14 to 63 cents per hour; and thus, a copay is the equivalent of charging a minimum wage worker over $200 for a medical visit in several states. Furthermore, while copays allow prison systems to partially recover health care costs, the amount recouped is often minimal relative to costs.

"The fees (...) often fail to fulfil their purported purpose of recouping costs and instead deter incarcerated people who are sick from receiving the care they need," the lawmakers wrote. "These fees can therefore lead to worsened long-term health outcomes and increased spread of infectious diseases-like COVID-19. For example, in 2003, the Centers for Disease Control and Prevention directly identified copays as one of the factors contributing to an outbreak of Methicillin-resistant Staphylococcus aureus (MRSA) among imprisoned people in several states."

In their letter, the lawmakers also cited a 2017 Government Accountability Office (GAO) report that found that the BOP "lacks or does not analyze certain health care data necessary to understand and control its costs," including "data on the health care services it provides to inmates." GAO also issued a series of recommendations to the BOP to improve its collection and analysis of health care data, but the BOP does not appear to have fully implemented any of those recommendations.

"This lack of data has prevented the BOP from understanding its health care costs and the factors driving up costs. It also means the BOP cannot research the efficacy of the copays it charges at either deterring incarcerated individuals from misusing the medical system or defraying health care costs," the lawmakers wrote

The lawmakers also asked DOJ Attorney General William Barr and BOP Director Michael Carvajal to respond to a series of questions no later than November 30, 2020 regarding policy adjustments made in response to COVID-19 outbreaks, the effect copays have had on its spread, and data on health care use prior to and throughout the pandemic.

Since the start of the COVID-19 pandemic, Senator Warren has pressed for action and legislation to mitigate the rampant spread of COVID-19 throughout correctional facilities. This includes introducing legislation to require weekly testing and data collection standards in federal prisons, requesting information on prisoner transportation services, inquiring about COVID-19 response plans to protect both inmates and correctional staff, and urging reevaluation of harmful practices that increase the risk of outbreaks amongst prison populations.