The Louisiana State Capitol. (Philip Kiefer/The Lens)

A bill that would eliminate medical co-pays for people incarcerated in Louisiana prisons was up for debate in a Wednesday committee meeting at the Louisiana legislature. But a vote was deferred to allow the bill’s sponsor and the Department of Public Safety and Corrections officials to work on a compromise — which could result in co-pays being reduced or waived when people have limited money in their prison accounts but not eliminated altogether. 

Currently, prisoners in Louisiana are required to pay $2 for a prescription, $3 for a sick call, $6 for an emergency visit, according to a report  by Loyola University New Orleans College of Law, LSU Health, and nonprofit group Voice of the Experienced. But advocates argue that the miniscule wages people make in prison — which in Louisiana can be as low as a few cents an hour — the co-pays are the equivalent to hundreds of dollars in the outside world, and can mean that prisoners often are choosing between going to the infirmary or purchasing food or clothing from the commisary. 

The bill was sponsored by Rep. Mandie Landry, Democrat of New Orleans. At the hearing in the House Committee on Criminal Justice Administration on Wednesday, Landry said people  in custody should not be forced to spend days worth of wages on medical care, and that “on principle that the state has an obligation to provide medical care for the people who are incarcerated.”

But Natalie LaBorde, an attorney with the DOC, said at the meeting that while changing the co-pay system was something the department was working on, officials had some concerns about potential abuse of medical care without any co-pay in place, given the limited medical staffing the department has. However, she added that individual instances of abuse were “not reflective of the entire population at all.”

She suggested that prescription co-pays could be eliminated completely, and the others capped at two dollars. In addition, she suggested that if a prisoner has less than two hundred dollars in their account, the co-pay could be waived. 

Will Harrell, with Voice of the Experienced, an advocacy group for people who are incarcerated, spoke in support of the bill, but said he was sensitive to the DOC concerns that the bill “could create a floodgate of requests to an already understaffed medical service.” He said he thought a compromise could be worked out in the coming weeks. 

“We’re the last people that would come in here trying to do anything like that — anything that would obstruct people who have a legitimate health care needs from getting those addressed,” Harrell said.

Rep. Debbie Villio, Republican of Kenner, who previously served as Jefferson Parish’s criminal justice director, noted that no one was being denied care if they couldn’t afford a co-pay. And she said that she thought people incarcerated should be forced to pay something if they received medical care and if they had any money to spend on food or other items.

“I was the umbrella agency over the jail,” Villio said of her time working for Jefferson Parish. “And you had inmates spending lots of money on candy chips — you name it. Yet my budget was paying for their toothpaste, for them to watch TV, etc.”

But Ronald Marshall, a member of Voice of the Experienced, who served 25 years in prison, said that for some people in prison — particularly those who did not have family support to put money in their accounts — the co-pay absolutely prevented them from getting medical care that they needed. 

He even said that at times, people on the same prison tier would agree to purchase food for another person incarcerated with them if they were sick so they could use their limited money to get medical care, in hopes that they would be less likely to spread it to other prisoners. 

“It’s four cents an hour,” Marshall said. “32 cents a day. That’s nine days of work for three dollars. … They don’t get denied medical treatment as Representative Villio said. No, they’re not denied. But the  barrier with the co-pay, and the choices that must be made — that’s the problem.”

Medical co-pays are common in prison systems across the country. According to the Prison Policy Initiative (PPI), Louisiana is one of 40 states to require them, along with the federal prison system. 

A number of states — including Louisiana — temporarily suspended co-pays when the COVID-19 pandemic began in 2020. But apparently they are being collected again. According to LaBorde, prisoners spent $170,000 on co-pays last year, compared to around $17 million on commissary items. (A departmental spokesman did not respond to a question about when the COVID suspension was lifted.)

In addition to individuals being forced to make difficult choices about their care, PPI argues that co-pays make care more expensive in the long run by making it less likely that prisoners will get preventative care that they need, and also by making it more likely that disease will spread in an institution.

“Medical copays encourage a dangerous waiting game for incarcerated people, correctional agencies, and the public, with little payoff in terms of offsetting medical costs and reducing ‘unnecessary’ office visits,” they argue in a report on the issue. 

“The co-pay prevents guys from getting the help they need,” Marshall with VOTE said at the meeting. “Simple as that. That’s the culture in DOC. That’s how the rubber hits the road.”

Nick Chrastil

Nicholas Chrastil covers criminal justice for The Lens. As a freelancer, his work has appeared in Slate, Undark, Mother Jones, and the Atavist, among other outlets. Chrastil has a master's degree in mass...