Rachel Wiggins


The attitude of acquiescence in legislatures and courts has permitted the American prison system to develop a practice of exploiting the health of its incarcerated population as an additional and excessive form of punishment. This article focuses on a practice widely used in prisons-the imposition of medical copayments- which contributes to the current culture of endangering the physical and mental health of incarcerated persons, all in the name of cost cutting and prisoner control. The problem of medical copayments could be solved by both the courts, which could recognize that the practice serves no legitimate penological interest, and the states themselves, which could pursue other avenues for funding medical costs for prisoners or look to affordable treatment options external to incarceration facilities. Part I offers some historical context behind the development of mass incarceration as accepted government policy and the resulting budgetary problems that gave rise to the imposition of copayments on the inmates themselves, then continues with explanations and refutations of three major justifications posited by prison policymakers for charging medical copayments. Part II introduces the current judicial state of the provision of prison health care and the concept of judicial deference to the decisions of prison officials, then proceeds with a discussion of legislative silence on the shifting of incarceration costs from governments to their incarcerated populations and the associated problems with such a policy. Part III offers potential solutions to help minimize fees charged to those behind bars, while also suggesting large scale changes that would help to contain the costs of incarceration that currently burden the American government at all levels. This article concludes that it is both possible and realistic for the American system to strike a balance between the need for administrative efficiency in prisons and prisoner health, safety, and rehabilitation.