Some experts say charging people in prison for medical care can deter them from seeking treatment. SHANE BEVEL/For The Frontier
Inmates in Oklahoma prisons might have to pay almost a month’s salary to see a doctor.
The state’s Department of Corrections charges inmates a $4 co-pay for non-emergency doctor visits or medications prescribed, and although the state’s minimum wage sits at $7.25 an hour, an inmate might have to work for a month to earn that much.
A report released by the nonprofit Prison Policy Initiative last week highlights the costs of medical care, which can be steep for people in prison.
Though some experts believe the fees deter inmates from seeking needed health care, state DOC officials say they can play an important role, helping to dissuade frivolous use of the system.
In at least 42 states, incarcerated people must pay a fee to see a medical provider, and although the report didn’t include inmate wage data for Oklahoma, The Frontier requested the information from the state’s DOC and compared it to the rest of the United States.
“It’s just particularly bad for poor people,” said Wendy Sawyer, author of the report and policy analyst for the Prison Policy Initiative.
“The people who are in prisons or jails are typically coming from some of the poorest communities to begin with,” Sawyer said. “So they are people who don’t necessarily have families sending them money to cover that, which means they have to come up with it out of their own pockets, which is hard to do when you’re making almost nothing, and in some cases, actually nothing.”
[perfectpullquote align=”full” cite=”” link=”” color=”” class=”” size=””]“We want a real-world environment for the prisoners because in the real world you and I would be required to have a copay, so we want them to have that experience, as well.” DOC spokesman Mark Myers [/perfectpullquote]
Instead of an hourly wage, Oklahoma inmates are paid monthly ranging from $7.23 to $14.45 for more skilled work. Some are paid up to $27 each month, but those jobs go to a “very limited” number of inmates. During the first month of work — an evaluation period — inmates aren’t paid.
Out of that income, 20 percent must be placed in a savings account.
Oklahoma’s co-pay for inmates falls slightly above the national average of $3.47. The highest fee for prisoners is $8 in Nevada, according to the report. Eight states don’t charge a fee for doctors’ visits.
A similar practice can be seen in county jails. In the Tulsa Jail, inmates are charged an $8 co-pay to see a doctor and $3 for medications.
Casey Roebuck, a spokeswoman for Tulsa County Sheriff’s Office, said if an inmate can’t afford the charge, their account balances will be negative. The agency doesn’t attempt to collect the debt once the inmate leaves the jail, she said in an email.
The state’s DOC doesn’t charge people in their facilities for health care such as mental health services, emergency care or certain medications. The agency won’t deny offenders health care if they can’t afford it, staying in line with a 1976 Supreme Court ruling in Estelle v. Gamble that guarantees inmates “adequate” healthcare.
However, Sawyer said the co-pay deters inmates who don’t want to accrue debt or have to make the choice between seeking medical care or buying items in commissary, such as toilet paper, hair care products or over-the-counter medications.
A $4 copay would be about 70 percent of the wage of an inmate making $7.23 each month after depositing a portion in his or her savings account.
A $7.23 monthly wage would translate to about an earned 5 cents per hour, assuming the inmate worked 22 days per month with seven-hour workdays, Sawyer concluded. A $4 co-pay for someone earning that much would be the equivalent of a $580 co-pay to a non-incarcerated minimum wage earner in Oklahoma.
*30-day evaluation period. Data from Oklahoma Department of Corrections
The National Commission on Correctional Health Care concluded in a 30-year evaluation of prison healthcare systems that charging inmates might hinder access to healthcare.
Though NCCHC acknowledges sick call can be abused by some people, charging for health care sets up two tiers of inmates: “Those who have funds to get medical care and commissary privileges, and those who have to choose between the two.”
Additionally, inmates might not understand they can be seen by a doctor regardless of whether they can pay, the organization concluded.
Rising costs in incarceration
Meanwhile, the state’s Department of Corrections must cut $2.96 million from its budget by the end of the fiscal year.
Copays can help offset medical costs, said DOC spokesman Mark Myers.
“Obviously not a large portion, but a very small portion of that cost,” he said. “It also cuts down on frivolous use of the medical system.”
The fees can also serve as a helpful experience for inmates, Myers said.
“We want a real-world environment for the prisoners because in the real world you and I would be required to have a copay, so we want them to have that experience, as well,” he said. “Especially because most of our prisoners want to be released one day.”
In 2016, the agency collected just over $250,000 in medical copays, Myers said. That same year, DOC spent about $84.4 million on health care — up almost 35 percent from FY 2011.
The increase is partially due to Oklahoma’s aging inmate population, which is quickly growing.
“There are specific medical needs that a person has when they get older so we do see that as contributing to increased medical costs,” Myers said.
Lynn Powell, president of OK CURE, an inmate advocacy group based in Tulsa, said she believes access to healthcare in prison is lacking, and the co-pay discourages people from seeking treatment.
“If they don’t think they have the money, just like out there in the free world, they just won’t go to the doctor,” Powell said.
During a state DOC board meeting on Tuesday, director Joe Allbaugh announced the agency reached a record 62,000 people in the corrections system, leaving state prisons at 109 percent capacity.
[perfectpullquote align=”full” cite=”” link=”” color=”” class=”” size=””]“All of these people are going to be released. They’re coming back to their communities and they’re going to be part of our regular health infrastructure. So those expenses are going to be passed on to communities eventually.”Wendy Sawyer, policy analyst for the Prison Policy Initiative[/perfectpullquote]
“What bothers me is back in December we hit a record population of 61,000,” Allbaugh said.
As a cost-cutting measure, Allbaugh issued a purchasing freeze in March. Items such as food, medical supplies and healthcare treatment were exempt from the freeze.
More efforts were taken last month when Allbaugh issued a hiring freeze for most of the agency and canceled 10 county jail contracts.
Data indicates many people coming into DOC custody are unhealthy, which further contributes to growing medical costs. More than half of all people in prison and jail had a mental health problem.
Sawyer said when inmates put off medical care, the treatment is going to be more expensive when they eventually seek it.
A 2009 study found that inmate access to health was poor across the nation.
“All of these people are going to be released,” Sawyer said. “They’re coming back to their communities and they’re going to be part of our regular health infrastructure. So those expenses are going to be passed on to communities eventually.”
