[Congressional Record Volume 145, Number 48 (Thursday, March 25, 1999)]
[Extensions of Remarks]
[Page E594]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               FEDERAL PRISONER HEALTH CARE COPAYMENT ACT

                                 ______
                                 

                            HON. MATT SALMON

                               of arizona

                    in the house of representatives

                        Thursday, March 25, 1999

  Mr. SALMON. Mr. Speaker, I rise to introduce the Federal Prisoner 
Health Care Copayment Act, which would require Federal prisoners to pay 
a nominal fee when they initiate certain visits for medical attention. 
Seventy-five percent of the fee would be deposited in the Federal Crime 
Victims' Fund and the remainder would go to the Federal Bureau of 
Prisons (BOP) and the Marshals Service for administrative expenses 
incurred in carrying out this Act. Each time a prisoner pays to heal 
himself, he will be paying to heal a victim. The U.S. Department of 
Justice supports the Federal inmate user fee concept, and has worked on 
crafting the language contained in this bill.
  Most law-abiding Americans pay a copayment when they seek medical 
attention. Why should Federal prisoners be exempted from this 
responsibility?
  This reform on the Federal level is overdue. Health care costs for 
Federal prisoners has risen considerably over the past several years. 
Only a handful of states exceed the Federal system in the cost of care 
per inmate. Establishing a copayment requirement would exert an 
immediate downward pressure on prison health care costs.
  States have recognized he value of copayment programs, and they have 
proliferated in recent times. Now, well over half of the states (at 
last count 34) have copayment programs on a statewide basis, including 
Alabama, Arizona, California, Colorado, Connecticut, Delaware, Florida, 
Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, 
Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New Hampshire, 
New Jersey, North Carolina, Ohio, Oklahoma, Rhode Island, South Dakota, 
Tennessee, Texas, Utah, Virginia, Washington, West Virginia, and 
Wisconsin. Additional states are considering implementing copayment 
programs. Moreover, at least half of the states--some of which have not 
enacted this health care reform on a statewide basis--have jail systems 
that impose a copayment on inmates seeking certain types of health 
care.
  Copayment programs have an outstanding record of success on the State 
level. In June 1996, the National Commission on Correctional Health 
Care held a conference that examined statewide fee-for-service 
programs. Dr. Ron Waldron of the Bureau of Prisons concluded that 
``inmate user fees programs appear to reduce utilization, and do 
generate modest revenues.''
  Evidence of the effectiveness of copayment programs continues to 
surface. Tennessee, which began requiring $3 copayments in January 
1996, reported in late 1997 that the number of infirmary visits per 
inmate had been cut almost in half. In August, prison officials in Ohio 
evaluated the nascent State copayment law, finding that the number of 
prisoners seeing a doctor had dropped 55 percent and that between March 
and August the copayment fee generated $89,500. And in my home state of 
Arizona, there has been a reduction of about 30 percent in the number 
of requests for health care services.
  Copayment programs reduce the overutilization of health care services 
without denying the indigent of necessary care. In discouraging the 
overuse of health care, prisoners in true need of attention should 
receive better care. Taxpayers benefit through the reduction in the 
expense of operating a prison health care system. And the burden of 
corrections officers to escort prisoners feigning illness to health 
care facilities is reduced.
  The Federal Prisoner Health Care Copayment Act provides that the 
Director of the Bureau of Prisons shall assess a nominal fee for each 
health care visit that he or she--consistent with the Act--determines 
should be covered. The legislation also allows state and local 
facilities to collect health care copayment fees when housing federal 
prisoners.
  The Federal Prisoner Health Care Copayment Act prohibits the refusal 
of treatment for financial reasons or appropriate preventative care.
  Finally, the Act requires that the Director report to Congress the 
amount collected under the legislation and an analysis of the effects 
of the implementation of this legislation on the nature and extent of 
health care visits by prisoners.
  Congress should speedily enact this important prisoner health care 
reform bill. I look forward to working with my colleagues and the 
Department of Justice to pass this proposal.

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