The COVID-19 pandemic has shattered the illusion that what goes on inside prisons has no consequences for the world outside. When outbreaks of the coronavirus raged behind bars, they spilled into the surrounding community through the coming and going of prison staff and the revolving door of jail incarceration. The pandemic proved once again that prisons are not hermetically sealed off from our communities, but rather are a deeply interconnected part of them.

That’s why eliminating medical copays for incarcerated people is a public health issue.

We call upon state and county officials to abolish medical copays in prisons and jails. This week, we take a closer look at why the pandemic has sent a loud and clear message that eliminating barriers to health care in prisons is not just about supporting the wellbeing of incarcerated people, their loved ones, and prison staff--it’s better for the health of the whole community.

The pandemic shows how the health of prisons and their communities are intertwined

Over two weeks in January, the number of coronavirus cases in rural Forest County, Pennsylvania, more than tripled. In a county with fewer than 8,000 residents, over 800 more people became infected, making this woodsy swath of northwestern Pennsylvania for a time the most heavily infected county per capita in the United States. A massive outbreak at Pennsylvania’s third largest state prison, SCI Forest, was driving this spike in infections.

The county’s emergency services director worried the outbreak would spread into the county’s largest town through prison employees, who “stop in the stores here in town on the way to work and the way home." Two dozen SCI Forest staffers had already tested positive.

We can’t say exactly how many more infections in Forest County occurred as a result of the massive prison outbreak. But studies have tried to estimate how many extra cases of COVID-19 were generated by correctional facilities, which, because they concentrate large numbers of people in an environment vulnerable to outbreaks of infectious diseases, can serve as incubators that fuel the spread of a virus. A statistical analysis by the Prison Policy Initiative estimated that prisons and jails in the United States were responsible for 500,000 cases of COVID-19 occurring both inside and outside their walls during the summer of 2020 alone. In Pennsylvania, they contributed over 20,000 new cases, according to the researchers.

Another recent study looked at how this dynamic played out in a single city--Chicago, Illinois--last year. Harvard University researchers found that 13 percent of the COVID-19 cases the city had had up until August 2020 could be linked to people cycling through Cook County Jail during the first month of the pandemic. They also zoomed in on the impact in specific neighborhoods. For each person from a given zip code who was arrested and jailed, there were five additional cases of COVID-19 in that community that could be attributed to the jail. Moreover, the jail’s role in disseminating the virus contributed to racial disparities in susceptibility to COVID-19, accounting for 21% of the disparities seen in Chicago.

These studies offer proof of what prison and public health officials already know to be true: infectious disease outbreaks can easily travel back and forth across prison walls. As one of the authors of the Chicago jail study has written, the pandemic “is making the fact that carceral conditions are inseparable from community health...clearer than ever.”

Copays undermine efforts to control outbreaks

Public officials also know that barriers to accessing health care in prison, including copay charges, can make outbreaks worse. Early in the pandemic, a paper written by a group of correctional physicians in the American Journal of Preventive Medicine cited “medical copays that demand a substantial portion of a prisoner's income” as a factor that could “prevent the timely identification, isolation, treatment, and referral of cases.” State prison systems appeared to share this concern. A number of states decided to suspend copays for all medical visits during the pandemic. But many, including Pennsylvania, only waived the charges for “respiratory, flu-related, or COVID-19 symptoms.”

Still, the experience of incarcerated people in Pennsylvania suggests that the copays remained a barrier. One incarcerated person who responded to a Prison Society survey last winter said that people who ultimately tested negative for COVID-19 were still being charged the copay, regardless of the symptoms they came in with. “This makes inmates uneasy about reporting symptoms and causes them to ‘hide’ when sick,” he wrote. After the Prison Society shared this feedback with the Department of Corrections, it expanded its copay waiver to include all medical visits and later suspended the fees indefinitely. Corrections Secretary John Wetzel noted that the fees had discouraged some incarcerated people possibly suffering from COVID-19 from reporting their symptoms.

If the possibility of being charged a copay led some people who were sick to avoid medical care, it allowed undetected cases of COVID-19 more time and opportunities to spread. We don’t know how many infections and deaths might have been prevented had the copay been eliminated completely. But we do know that any policy that deters incarcerated people from seeking medical care undermines efforts to control outbreaks of infectious disease, whether it’s COVID-19, the flu, or an antibiotic-resistant strain of bacteria. And because prisons are inextricably linked with the world outside, controlling these outbreaks is a grave concern for public health.

The Prison Society once again calls on all state and county officials to permanently eliminate all medical copays in prisons and jails. At the state level, we call on elected representatives to pass legislation ending the $5 copay in state prisons.

In addition, the Prison Society once again calls on all state and county officials to:

• Expand efforts to safely reduce the number of people in custody;
• Continue to offer COVID-19 vaccinations to all people in custody and staff in prisons and jails;
• Implement weekly, rapid testing of all staff that come into contact with people in custody until they are vaccinated;    
• Require that every county publicly report prison testing results and virus-related deaths in custody; and
• Test and quarantine every new person entering custody.

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