California Prisoners Freed From Medical, Dental Copays By Bill

Assembly Bill 45 overturns a policy few knew even existed.

Donald Ray Debose exercises in the yard at San Quentin State Prison’s death row in San Quentin, Calif. Tuesday, August 16, 2016. Photo by Jessica Christian

It’s not easy to earn money while in prison.

The factory jobs that are available — such as making license plates, sewing uniforms, or maintaining prison facilities — pay $0.08 and $0.37 per hour. Half of that income commonly goes to restitution, which means that on average, a person incarcerated in a California prison makes only $1 to $6 per week.

To an outsider, that may not seem like a big issue. Aside from items from the commissary, what is there to spend money on while behind bars? But the truth is uncomfortable: Among other things, California prisoners are required to provide copays for medical or dental visits. While in prison that’s commonly only $5, it’s not an easy sum to come up with while being paid $0.08 an hour.

It’s an issue criminal justice reform advocates have been fighting for years — and now, it appears they may have won. On Sept. 10, Assembly Bill 45 cleared the Senate with 29 votes of support (including two Republicans). If Governor Gavin Newsom signs off on it, all medical copays at jails and prisons across the state of California will be eliminated.

It was Romarilyn Ralston from the California Coalition for Women Prisoners who first got the issue in front of Assemblymember Mark Stone of Monterey, Santa Clara, and Santa Cruz counties. The issue was originally folded into a 2018 bill authored by Stone, but was amended out after protest from the California Department of Corrections and Rehabilitation. It was reintroduced as its own bill this year.

AB 45 hasn’t received the same attention as other criminal justice reform measures like Assembly Bill 392 to hold police more accountable when using deadly force, or Newsom’s move earlier this summer to eliminate the death penalty. But for people who are incarcerated, AB 45’s effects could be life-changing.

Juan Haines is small. He’s 5’3”, and 125 pounds. Currently incarcerated at San Quentin Prison, he’s struggled with severe dental issues for years but hasn’t been able to afford the cost of care. A set of dentures cost $255, and each visit to the dentist to pull a tooth was $5. After restitution, Haines only earns $25.40 a month.

He put off the procedure for months out of concern over the cost. But after having so many teeth pulled that eating became nearly impossible, he gave in.

“I signed a trust withdrawal for $255 to be charged to my prison account,” Haines tells the Ella Baker Center for Human Rights. “Sitting in that dentist chair, I thought about the year’s pay it would take to stop the drooling out of my mouth from my missing front teeth.”

Haines’ story is sadly not unique. For those who visit a doctor without sufficient funds to afford a copay, a hold is placed on their account, blocking them from purchasing phone cards to call home, toiletries, or over-the-counter medicine.

And while the agony of untreated dental work is a common experience across prisons in California, medical providers warn of other side effects of unaffordable copays. Infections and diseases that are easily treatable in early stages are left until they become severe, endangering other people in prison. The close quarters, low-nutrition food, and limited access to hygiene mean that diseases can spread rapidly, making it even more important for treatment to be offered quickly. In 2003, the Centers for Disease Control and Prevention credited unaffordable copays as one of the key factors in an outbreak of MRSA in California prisons.

“People who are most likely to be incarcerated are also the most likely to have chronic healthcare issues,” Eric Henderson, policy director of advocacy group Initiate Justice, tells SF Weekly. “By imposing a fee to access care, we are expecting currently incarcerated people to triage themselves. Ultimately, this exacerbates existing conditions and puts their health and the health of others at risk.”

In addition to causing all these issues, the copays don’t even bring in much money — they’re a pittance in the larger scheme of prison funding, and the resulting emergency medical procedures from untreated issues are costly.

“Although the copayment program was authorized with the intention of reducing the financial and administrative burden of prison health care, there is no data demonstrating that the program is cost-effective,” reads the text of AB 45. “Analyses of copayment programs in other states have found that the administration of copayment programs in correctional institutions often costs more than the revenue collected from incarcerated people.”

Other states have already caught up to this: Missouri, Montana, Nebraska, New Mexico, New York, Oregon, Vermont, and Wyoming have already eliminated copays in jails and prisons.  And while AB 45 has yet to be officially signed by Newsom, the California Department of Corrections and Rehabilitation pre-emptively eliminated copays on March 1 of this year. AB 45 will make it official.

For Haines, who expected to take a year to fully pay off his dentures, this elimination of debt was life-changing.

“Around March 2019, surprisingly, all of the money paid for my teeth popped up on my trust account,” he says. “A couple days later, I went to the dentist and my teeth were there.”

Haines now has a smile he says his friends compliment him on. But the trauma of accessing care still weighs on him. “I wouldn’t want anyone to go through the emotional and financial roller coaster that I did to get dental care,” he says.

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