By Brian R. Wyant

As an unpopular Congress continues to debate the merits of the 2010 Affordable Care Act, and consumers attempt to navigate the troubled HealthCare.gov website, far from the national consciousness is the only group of people who have a constitutional guarantee to health care: prisoners. Unlike the federal government, prisons cannot shut down, but current policies have shut out many inmates from receiving health care.

Currently, all federal prisons and the vast majority of state prisons require an inmate co-payment system. Although inmates are allowed to work, their pay is far below minimum wage and has remained generally stagnant, but medical co-payment fees have nearly tripled over the last 10 years.

In Pennsylvania, for self-initiated physician requests, inmates are charged $5, and an additional $5 for related prescriptions. The inmate co-payment system was designed to generate revenue and reduce correctional health-care costs, as it was believed the fees might eliminate or at least lower unnecessary use of services. However well-intended, though, the policies have some questioning whether the Pennsylvania Department of Corrections, which is legally responsible for providing basic medical care for prisoners, is ultimately denying necessary medical care.

Although $5 or $10 does not seem like a great deal of money, especially when many people on the outside struggle to find work and pay for increasing health-care costs, the fees charged to prisoners create an almost insurmountable barrier for inmates seeking health care.

Generally, inmates in a Pennsylvania correctional institution are allowed to work a maximum of 30 hours a week, earning 19 to 42 cents an hour. Working inmates earn from slightly more than $20 to a little more than $50 a month. That $5 co-pay to see a nurse or doctor for a simple visit amounts to 10 to 25 percent of their monthly income, or even more if they are given prescriptions.

Interviews I conducted with a fellow researcher at Graterford Prison in Montgomery County confirmed that the co-payment is a significant barrier for many inmates who are trying to see a medical professional. Despite the popular belief that everything is free in prison, inmates often must purchase some personal items, such as additional hygienic supplies, phone time, and even basic items such as thermal shirts.

Many inmates are not sympathetic figures, and citizens often understandably ask why inmates, some of whom have committed horrific acts, deserve health care when approximately 15 percent of the non-incarcerated population is without health insurance, and others work extra hours to try to keep up with ever-increasing costs. However, not only has medical co-payment in prisons generated insignificant revenue, but these fees have contributed to inmates' avoiding the use of medical services, leading to possibly more severe health problems, possible infectious disease outbreaks, and higher associated costs in the long-term. Also, correctional officers are not immune from disease outbreaks, as they work in extremely close quarters with inmates. Creating a healthier environment in prisons might not only decrease the risk of inmates getting sick, but also reduce the health risk faced by staff. Others may simply frame the question as whether it is fair to ask a population that is disproportionally poor to pay, in some cases, half of their salary to be seen by a doctor and get a prescribed antibiotic.

The United States already has the highest incarceration rate in the world and an aging prisoner population. Even those who are sickened by the thought of inmates who may have caused serious harm to others receiving any health services must come to grips with the reality that barriers to basic health-care services will cause more problems later, as disease or illness is often less expensive to treat in the initial stages, and with individual patients rather than many related cases. Seeing a physician early could prevent more harmful conditions, and early detection might avert transmission to others.

Large gains in prisoner health might be made by simply lowering the co-payments to a more manageable price. Since the income generated is only modest, the state would not lose significant revenue, and, considering the low pay inmates receive, even a small fee would likely deter system abuse without posing the current barrier to those who need care.

Reforming the prison health-care system with more manageable fees will cost taxpayers less if we do it now, and it will cost them more if we delay.

Brian R. Wyant is an assistant professor in the Department of Sociology and Criminal Justice at La Salle University. wyant@lasalle.edu