Governor Rauner’s Amendatory Veto of HB5104 is Bad for Prisoners, Policy and the Public

On August 22, 2018 Governor Rauner issued an amendatory veto to House Bill 5104, which abolished the $5 co-pay Illinois prisoners must pay to see a doctor. The Governor cited balancing “the need to provide medical services with potential abuses of a free medical system that could create significant backlogs in an already overburdened Corrections healthcare system.” This decision is incredibly disappointing and the reasoning behind it flies in the face of research and correctional realities. There is little or no substantiation for the assertion that without a medical co-pay, prisoners will seek medical attention regardless of medical need; there is a plethora of evidence demonstrating correctional medical co-pays result in poorer overall health for prisoners and staff as well as increased costs to the state due to administrative expenses and heavier utilization of expensive emergency treatments.

HB5104 passed the Legislature with bipartisan support, and the Illinois Department of Corrections, the agency most impacted by this legislation, took a neutral position on it. The fact that the agency charged with the medical care of the state’s incarcerated population did not oppose abolishing the $5 co-pay is evidence that concerns about abuses of the prison healthcare system are not founded on fact or experience. Illinois is not alone in recognizing this; the National Commission on Correctional Health Care opposes inmate co-pays as an obstruction to quality, necessary healthcare in prisons.

Governor Rauner recommended reducing the current $5 co-pay for inmates to $3.90, the co-pay for Medicaid recipients in Illinois. His proposition to reduce the inmate co-pay to the same amount as that paid by Medicaid recipients is ill-advised because it ignores that prison economies are closed economies, not free markets of labor, goods and services; it also demonstrates a lack of regard for basic principles of social policy. Reducing the copay amount by $1.10 has little to do with Illinois’ ability to meet its obligation to provide adequate correctional health care to the entire incarcerated population. This change will perpetuate the same dysfunctional correctional healthcare outcomes currently present in a system that is rife with flaws in the both the quality and delivery of services. As it stands, Illinois is in the midst of massive litigation based on gross deprivations of medical and mental health care to prisoners in violation of the eighth amendment prohibition against cruel and unusual punishment.

Though a $5 co-pay, or a $3.90 co-pay for that matter, may not seem like much money to some people, this cost is prohibitively expensive for most inmates. For those who do not have a work assignment and are receiving only $10 monthly in “state pay," one healthcare visit can eat up a significant portion of their monthly income. For many prisoners, the $10-a-month “state pay” is their only source of income to pay for many basic necessities including not only medical care, but also items such as hygiene products, socks, underwear, postage stamps, laundry detergent, small fans to mitigate dangerous heat conditions in cells, and phone calls to loved ones (which incur charges at far higher rates than phone calls made outside of a correctional environment). Asking incarcerated people to make choices between medical care and these basic necessities is inhumane and detrimental to them as well as to the entire state.

The reality is that the prisoner population in Illinois is largely poor, as are many of their families, and the medical co-pays act as a significant deterrent to seeking necessary medical care for many of them. This has negative repercussions for individuals, other prisoners, staff inside our prisons, and society as a whole.  When prisoners defer getting medical treatment due to economic hardship and inability to pay, there is an increased risk of contagion. Further, delayed care necessitates more serious and expensive treatment as medical conditions worsen and become more acute.

The vast majority of people in prison are released back into the community. Governor Rauner’s misguided position on prison medical co-pays ignores that prison health is public health in that the release of prisoners with untreated, undiagnosed medical conditions back into the community undermines the health of all citizens. Governor Rauner’s actions on reforming the justice and prison systems are inconsistent with his declared goals of a smaller, more effective and rehabilitative system. Time and again the Governor stops short of enacting meaningful change, evidencing a disconnect between his words and actions when it comes to criminal justice reform. Real change that will lead to a more fair and effective criminal justice system and to a correctional agency that can restore incarcerated individuals to productive citizenry requires bold action, not half steps and abdication.