[Congressional Record Volume 146, Number 111 (Tuesday, September 19, 2000)]
[House]
[Pages H7806-H7811]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           FEDERAL PRISONER HEALTH CARE COPAYMENT ACT OF 2000

  Mr. PEASE. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 1349) to amend title 18, United States Code, to combat the 
overutilization of prison health care services and control rising 
prisoner health care costs, as amended.
  The Clerk read as follows:

                               H.R. 1349

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Federal Prisoner Health Care 
     Copayment Act of 2000''.

     SEC. 2. HEALTH CARE FEES FOR PRISONERS IN FEDERAL 
                   INSTITUTIONS.

       (a) In General.--Chapter 303 of title 18, United States 
     Code, is amended by adding at the end the following:

     ``Sec. 4048. Fees for health care services for prisoners

       ``(a) Definitions.--In this section--
       ``(1) the term `account' means the trust fund account (or 
     institutional equivalent) of a prisoner;
       ``(2) the term `Director' means the Director of the Bureau 
     of Prisons;
       ``(3) the term `health care provider' means any person who 
     is--
       ``(A) authorized by the Director to provide health care 
     services; and
       ``(B) operating within the scope of such authorization;
       ``(4) the term `health care visit'--
       ``(A) means a visit, as determined by the Director, by a 
     prisoner to an institutional or noninstitutional health care 
     provider; and
       ``(B) does not include a visit initiated by a prisoner--
       ``(i) pursuant to a staff referral; or
       ``(ii) to obtain staff-approved follow-up treatment for a 
     chronic condition; and
       ``(5) the term `prisoner' means--
       ``(A) any individual who is incarcerated in an institution 
     under the jurisdiction of the Bureau of Prisons; or
       ``(B) any other individual, as designated by the Director, 
     who has been charged with or convicted of an offense against 
     the United States.
       ``(b) Fees for Health Care Services.--
       ``(1) In general.--The Director, in accordance with this 
     section and with such regulations as the Director shall 
     promulgate to carry out this section, may assess and collect 
     a fee for health care services provided in connection with 
     each health care visit requested by a prisoner.
       ``(2) Exclusion.--The Director may not assess or collect a 
     fee under this section for preventative health care services, 
     emergency services, prenatal care, diagnosis or treatment of 
     chronic infectious diseases, mental health care, or substance 
     abuse treatment, as determined by the Director.
       ``(c) Persons Subject to Fee.--Each fee assessed under this 
     section shall be collected by the Director from the account 
     of--
       ``(1) the prisoner receiving health care services in 
     connection with a health care visit described in subsection 
     (b)(1); or
       ``(2) in the case of health care services provided in 
     connection with a health care visit described in subsection 
     (b)(1) that results from an injury inflicted on a prisoner by 
     another prisoner, the prisoner who inflicted the injury, as 
     determined by the Director.
       ``(d) Amount of Fee.--Any fee assessed and collected under 
     this section shall be in an amount of not less than $1.
       ``(e) No Consent Required.--Notwithstanding any other 
     provision of law, the consent of a prisoner shall not be 
     required for the collection of a fee from the account of the 
     prisoner under this section. However, each such prisoner 
     shall be given a reasonable opportunity to dispute the amount 
     of the fee or whether the prisoner qualifies under an 
     exclusion under this section.
       ``(f) No Refusal of Treatment For Financial Reasons.--
     Nothing in this section may be construed to permit any 
     refusal of treatment to a prisoner on the basis that--
       ``(1) the account of the prisoner is insolvent; or
       ``(2) the prisoner is otherwise unable to pay a fee 
     assessed under this section.
       ``(g) Use of Amounts.--
       ``(1) Restitution of specific victims.--Amounts collected 
     by the Director under this section from a prisoner subject to 
     an order of restitution issued pursuant to section 3663 or 
     3663A shall be paid to victims in accordance with the order 
     of restitution.
       ``(2) Allocation of other amounts.--Of amounts collected by 
     the Director under this section from prisoners not subject to 
     an order of restitution issued pursuant to section 3663 or 
     3663A--
       ``(A) 75 percent shall be deposited in the Crime Victims 
     Fund established under section 1402 of the Victims of Crime 
     Act of 1984 (42 U.S.C. 10601); and
       ``(B) 25 percent shall be available to the Attorney General 
     for administrative expenses incurred in carrying out this 
     section.
       ``(h) Notice to Prisoners of Law.--Each person who is or 
     becomes a prisoner shall be provided with written and oral 
     notices of the provisions of this section and the 
     applicability of this section to the prisoner. 
     Notwithstanding any other provision of this section, a fee 
     under this section may not be assessed against, or collected 
     from, such person--
       ``(1) until the expiration of the 30-day period beginning 
     on the date on which each prisoner in the prison system is 
     provided with such notices; and
       ``(2) for services provided before the expiration of such 
     period.
       ``(i) Notice to Prisoners of Regulations.--The regulations 
     promulgated by the Director under subsection (b)(1), and any 
     amendments to those regulations, shall not take effect until 
     the expiration of the 30-day period beginning on the date on 
     which each prisoner in the prison system is provided with 
     written and oral notices of the provisions of those 
     regulations (or amendments, as the case may be). A fee under 
     this section may not be assessed against, or collected from, 
     a prisoner pursuant to such regulations (or amendments, as 
     the case may be) for services provided before the expiration 
     of such period.
       ``(j) Notice Before Public Comment Period.--Before the 
     beginning of any period a proposed regulation under this 
     section is open to public comment, the Director shall provide 
     written and oral notice of the provisions of that proposed 
     regulation to groups that advocate on behalf of Federal 
     prisoners and to each prisoner subject to such proposed 
     regulation.
       ``(k) Reports to Congress.--Not later than 1 year after the 
     date of the enactment of the Federal Prisoner Health Care 
     Copayment Act of 2000, and annually thereafter, the Director 
     shall transmit to Congress a report, which shall include--
       ``(1) a description of the amounts collected under this 
     section during the preceding 12-month period;

[[Page H7807]]

       ``(2) an analysis of the effects of the implementation of 
     this section, if any, on the nature and extent of heath care 
     visits by prisoners;
       ``(3) an itemization of the cost of implementing and 
     administering the program;
       ``(4) a description of current inmate health status 
     indicators as compared to the year prior to enactment; and
       ``(5) a description of the quality of health care services 
     provided to inmates during the preceding 12-month period, as 
     compared with the quality of those services provided during 
     the 12-month period ending on the date of the enactment of 
     such Act.
       ``(l) Comprehensive HIV/AIDS Services Required.--The Bureau 
     of Prisons shall provide comprehensive coverage for services 
     relating to human immunodeficiency virus (HIV) and acquired 
     immune deficiency syndrome (AIDS) to each Federal prisoner in 
     the custody of the Bureau of Prisons when medically 
     appropriate. The Bureau of Prisons may not assess or collect 
     a fee under this section for providing such coverage.''.
       (b) Clerical Amendment.--The analysis for chapter 303 of 
     title 18, United States Code, is amended by adding at the end 
     the following:

``4048. Fees for health care services for prisoners.''.

     SEC. 3. HEALTH CARE FEES FOR FEDERAL PRISONERS IN NON-FEDERAL 
                   INSTITUTIONS.

       Section 4013 of title 18, United States Code, is amended by 
     adding at the end the following:
       ``(c) Health Care Fees For Federal Prisoners in Non-Federal 
     Institutions.--
       ``(1) In general.--Notwithstanding amounts paid under 
     subsection (a)(3), a State or local government may assess and 
     collect a reasonable fee from the trust fund account (or 
     institutional equivalent) of a Federal prisoner for health 
     care services, if--
       ``(A) the prisoner is confined in a non-Federal institution 
     pursuant to an agreement between the Federal Government and 
     the State or local government;
       ``(B) the fee--
       ``(i) is authorized under State law; and
       ``(ii) does not exceed the amount collected from State or 
     local prisoners for the same services; and
       ``(C) the services--
       ``(i) are provided within or outside of the institution by 
     a person who is licensed or certified under State law to 
     provide health care services and who is operating within the 
     scope of such license;
       ``(ii) constitute a health care visit within the meaning of 
     section 4048(a)(4) of this title; and
       ``(iii) are not preventative health care services, 
     emergency services, prenatal care, diagnosis or treatment of 
     chronic infectious diseases, mental health care, or substance 
     abuse treatment.
       ``(2) No refusal of treatment for financial reasons.--
     Nothing in this subsection may be construed to permit any 
     refusal of treatment to a prisoner on the basis that--
       ``(A) the account of the prisoner is insolvent; or
       ``(B) the prisoner is otherwise unable to pay a fee 
     assessed under this subsection.
       ``(3) Notice to prisoners of law.--Each person who is or 
     becomes a prisoner shall be provided with written and oral 
     notices of the provisions of this subsection and the 
     applicability of this subsection to the prisoner. 
     Notwithstanding any other provision of this subsection, a fee 
     under this section may not be assessed against, or collected 
     from, such person--
       ``(A) until the expiration of the 30-day period beginning 
     on the date on which each prisoner in the prison system is 
     provided with such notices; and
       ``(B) for services provided before the expiration of such 
     period.
       ``(4) Notice to prisoners of state or local 
     implementation.--The implementation of this subsection by the 
     State or local government, and any amendment to that 
     implementation, shall not take effect until the expiration of 
     the 30-day period beginning on the date on which each 
     prisoner in the prison system is provided with written and 
     oral notices of the provisions of that implementation (or 
     amendment, as the case may be). A fee under this subsection 
     may not be assessed against, or collected from, a prisoner 
     pursuant to such implementation (or amendments, as the case 
     may be) for services provided before the expiration of such 
     period.
       ``(5) Notice before public comment period.--Before the 
     beginning of any period a proposed implementation under this 
     subsection is open to public comment, written and oral notice 
     of the provisions of that proposed implementation shall be 
     provided to groups that advocate on behalf of Federal 
     prisoners and to each prisoner subject to such proposed 
     implementation.
       ``(6) Comprehensive hiv/aids services required.--Any State 
     or local government assessing or collecting a fee under this 
     subsection shall provide comprehensive coverage for services 
     relating to human immunodeficiency virus (HIV) and acquired 
     immune deficiency syndrome (AIDS) to each Federal prisoner in 
     the custody of such State or local government when medically 
     appropriate. The State or local government may not assess or 
     collect a fee under this subsection for providing such 
     coverage.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Indiana (Mr. Pease) and the gentleman from Virginia (Mr. Scott) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Indiana (Mr. Pease).

                              {time}  1600


                             General Leave

  Mr. PEASE. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
and include extraneous material on the bill now under consideration.
  The SPEAKER pro tempore (Mr. Shimkus). Is there objection to the 
request of the gentleman from Indiana?
  There was no objection.
  Mr. PEASE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the gentleman from Florida (Mr. McCollum), the chairman 
of the Subcommittee on Crime of the Committee on the Judiciary, was 
unavoidably detained and has worked a great deal with the gentleman 
from Arizona (Mr. Salmon) on this bill, and the gentleman from Florida 
has asked that I include for the Record his remarks on this bill, which 
I now do.
  Mr. Speaker, H.R. 1349, the Federal Prisoner Health Care Copayment 
Act of 1999, was introduced by the gentleman from Arizona (Mr. Salmon). 
It adds a new provision to title 18 to require the Bureau of Prisons to 
assess and collect a fee from inmates for health care services provided 
to the inmate. The Subcommittee on Crime and the full Committee on the 
Judiciary reported this bill favorably by voice vote. It is similar to 
S. 704, a bill that passed the other body by unanimous consent.
  Currently, inmates in the Federal Prison System receive free medical 
care from BOP employees, Public Health Services personnel, and private 
health care providers working under contract with the BOP. The purpose 
of the bill is to impose a type of copayment fee of a nominal amount on 
inmates, similar to the copayment fee paid by most Americans when they 
visit a health care provider under a managed health care plan.
  Under this bill, the fee would be collected from all inmates who 
request to see a health care provider. Under the bill as introduced, 
the director of the BOP would establish a sliding scale for the fee, 
dependent on an inmate's ability to pay, but in no event would the fee 
be less than $1 per visit.
  The fees to be collected under this bill will help insure that 
inmates do not abuse the free health care they receive while in prison. 
Economists tell us that any time someone is given something for 
nothing, they will use too much of it. Health care copayment fees are a 
way to ensure that people use an efficient amount of health care, 
whether they be ordinary citizens or inmates. Also, the Bureau of 
Prisons has testified before the subcommittee that it believes some 
inmates often sign up for sick call as a way of getting out of other 
responsibilities. This fee will also help deter inmates from abusing 
the system in that manner.
  The fee to be collected under the bill is limited in appropriate 
ways. For example, the fee will not be assessed for health care 
services that the BOP requires all inmates receive, nor would it be 
charged for return visits required by BOP doctors after the inmate's 
first voluntary visit. Inmates will also not pay the fee for diagnosis 
or treatment of chronic infectious diseases, mental health care, or 
substance abuse treatment. The bill also provides that if one inmate is 
injured by another inmate, the other inmate would be assessed the fee 
for the injured inmate's treatment. And, the bill states that inmates 
may not be refused treatment because they are insolvent or otherwise 
unable to pay the fee to be assessed under the bill.
  The fees collected from inmates who have been ordered to pay 
restitution on their victims are to be used for that purpose. Three-
quarters of the remaining fees are to be paid into the Federal Crime 
Victims Fund, and one-quarter is to be used by the Attorney General for 
administrative expenses in carrying out the requirements of the bill.
  The bill also allows State and local governments which are housing 
Federal inmates under a contract with the Federal Government to also 
assess such a fee, provided that the fee is authorized under the law of 
the State where the Federal inmate is housed and that State prisoners 
are charged no greater a fee.

[[Page H7808]]

  Mr. Speaker, I support this bill, the administration supports this 
bill, and I urge all of my colleagues to support this bill.
  Mr. Speaker, this ends the statement of the gentleman from Florida 
(Mr. McCollum).
  Mr. Speaker, I reserve the balance of my time.
  Mr. SCOTT. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in opposition to H.R. 1349, the Federal Prisoner 
Health Care Copayment Act. The bill authorizes the director of the 
Federal Bureau of Prisons to collect a fee of at least $1 from an 
account of a prisoner for each health care visit made by that prisoner. 
While we were successful through the amendment process to get certain 
health care services excepted from that fee, such as emergency visits 
and prenatal care, a prisoner must still pay a fee in most instances 
and for conditions as serious as infectious diseases.
  The gentleman from Indiana suggested that chronic infectious diseases 
would not be assessed a fee, but other prisoners with other infectious 
diseases will be discouraged from seeking care with the fee. 
Discouraging prisoners from getting necessary health care services by 
charging a copay violates the government's constitutional obligation to 
provide such services. It will not reduce prisoner abuse of the health 
care system, and it will end up costing the taxpayers money.
  Mr. Speaker, the Supreme Court has recognized the government's 
obligation to provide health care to prisoners. In 1976, in Estelle v. 
Gamble, the Supreme Court enunciated the principle that the government 
has an obligation to provide medical care to prisoners and this has 
been upheld in subsequent cases. For example, in 1989 in the DeShaney 
v. Winnebago County Department of Social Services the court stated, 
``When the States, by affirmative exercise of its power, so restrains 
an individual's liberty that it renders him unable to care for himself 
and, at the same time, fails to provide for his basic human needs; 
e.g., food, shelter, clothing, medical care and reasonable safety, it 
transgresses the substantive limits on State actions set by the eighth 
amendment and the due process clause.''
  Given the limited amounts of money on hand in Federal prisoner 
accounts at any given time, a health care copayment requirement will 
impede their access to needed health care, particularly at the early 
treatment and intervention stage. The Bureau of Prisons reports that 
the majority of inmates make less than 17 cents per hour, and more than 
half of all inmates have no more than $60 in their account at any time, 
including the day immediately after their monthly pay period. Thus, 
even a minor copay would constitute a significant burden.
  Establishing such a prerequisite to health care treatment not only 
undermines the government's constitutional obligation to provide 
medical care to inmates, but it also constitutes bad public policy. An 
inmate's failure to get timely treatment could result in a minor 
problem becoming a major problem, such as complications due to delayed 
detection of cancer or danger to others, resulting from untreated 
infectious diseases.
  Further, the proponents' argument that the copay will deter inmate 
abuse of health care services simply lacks merit. Obviously, inmates 
with substantial amounts of money will not be deterred by a dollar or 
so copay from seeking unnecessary health care, and further, those 
inmates who are actually seeking appropriate care will still have to 
pay the copay, and so it discourages those who are seeking appropriate 
health care as well as those seeking inappropriate health care.
  Therefore, a more likely effect of H.R. 1349 is their ability to pay 
will be the determining factor of whether an inmate seeks care and not 
whether the prisoner truly needs medical attention. Thus, it is not 
surprising when the Bureau of Prisons witnesses acknowledged at a 
hearing on H.R. 1349 that there is no way to know how many truly sick 
inmates will be deterred by the copay as opposed to those abusing the 
system.
  Further, since even those who are determined to be truly sick must 
pay, it appears that the real purpose of the bill is simply to deter 
inmates from seeking health care whether they need it or not. 
Consistent with that purpose, the majority opposed amendments in 
committee which would have required a copay only if the inmate is found 
to have no reasonable basis for seeking health care services.
  Finally, Mr. Speaker, there is a significant question as to whether 
the cost of administering the program will actually be greater than any 
savings projected. Proponents of the legislation point to States which 
have instituted inmate health care copayments to suggest that copays 
really work to discourage unnecessary health care and save the State 
money without jeopardizing the health care of inmates.
  However, the only study on this issue has been a study by the 
California State auditor which found that the California Department of 
Corrections' annual copay program, the annual cost of that program of 
$3.2 million amounted to almost five times the annual collections, 
wasting $2.5 million. Certainly, it is not surprising that these audit 
results prompted the California State auditor to recommend that the 
program be terminated.
  In conclusion, Mr. Speaker, this bill violates the government's 
obligation to provide health care services. It constitutes bad public 
policy by discouraging the truly sick from seeking health care, and it 
will end up costing the taxpayers money. Accordingly, I urge my 
colleagues to vote no on H.R. 1349.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PEASE. Mr. Speaker, it is my pleasure to yield such time as he 
may consume to the gentleman from Arizona (Mr. Salmon), the author of 
the legislation.
  (Mr. Salmon asked and was given permission to revise and extend his 
remarks.)
  Mr. SALMON. Mr. Speaker, I would like to, first of all, thank the 
committee chairman, the gentleman from Illinois (Mr. Hyde) for working 
so tirelessly on getting this piece of legislation to the floor. I 
would also like to thank the subcommittee chairman, the gentleman from 
Florida (Mr. McCollum) for all of his hard work and his commitment.
  As we can see from the poster board here, grandma pays a copayment 
when she seeks health care, but the criminals pictured here, John 
Gotti, Timothy McVeigh, Ramzi Yousef, and Aldrich Ames do not. Most 
law-abiding citizens like grandma pay a small fee every time they seek 
elective care. But the most despicable criminal element, terrorists, 
murderers and drug dealers face no such burden.
  Why should Federal prisoners be any different? The free health care 
currently enjoyed by Federal prisoners is an offense to every law-
abiding, hard-working American taxpayer who struggles to make ends 
meet. It is time to end the free ride for Federal prisoners by 
requiring them to contribute to the costs of their own care.
  The Federal prisoner health care copayment act puts an end to the 
unfair policy that permits convicts totally free access to unlimited 
health care. Also, under the act, every time a convict pays to heal 
himself, he will pay to heal a victim. Most of the copayments collected 
will be deposited in the Crime Victims Fund.
  The support for this bill is bipartisan and bicameral. The Senate 
version passed earlier last year with the support of everyone from 
Jesse Helms to Tom Daschle. The Federal Bureau of Prisons and the 
Department of Justice have endorsed the bill. At least 38 States have 
enacted prisoner health care copayment plans. The bill reflects many of 
the features of the successful State copayment laws.
  The Federal Prisoner Health Copayment Act simply requires the Federal 
Bureau of Prisons to collect a copayment of at least $1 for elected 
health care visits covered by the bill. The legislation applies to both 
inmates in the Federal Bureau of Prisons and those in the Federal 
system housed in non-Federal facilities such as county jails. It is 
expected that the Bureau of Prisons will adopt a sliding scale of fees 
to reflect the financial status of the inmates. Indigent prisoners 
would not be denied care. The fee would not be assessed for preventive 
health care services or emergency services, prenatal care, diagnosis or 
treatment for chronic infectious diseases, mental health care, or 
substance abuse treatment.

[[Page H7809]]

 The fee does not take effect until inmates are given prior notice. As 
mentioned above, every time a prisoner pays to heal himself, he will 
help to pay a victim.
  Mr. Speaker, 75 percent of the funds collected go to the Crime 
Victims Fund, and the remainder covers administrative costs. If the 
experience of 38 States that have copayment programs up and running is 
any indicator, the Federal measure will accomplish several important 
objectives. Most importantly, frivolous visits will be reduced, perhaps 
dramatically. The Federal prisoner health care system is being 
overutilized, if not abused. The legislation will ensure that every 
prisoner receives the care they need without forcing the taxpayers to 
pay for red carpet treatment not available to most law-abiding 
Americans.
  Consider some of the examples of how well this program has worked on 
the Statewide level. This is a list of all of the States in our 
country, 38, that have passed a copayment piece of legislation like I 
am introducing here today. Arizona estimates a 40 to 60 percent 
reduction in medical utilization. Florida experienced a 16 to 29 
percent reduction in health care visits. New Jersey inmates visits 
declined 60 percent. Kansas saw a 30 to 50 percent reduction. Nevada, a 
50 percent reduction, and Maryland, a 40 percent drop.
  Mr. Speaker, CBO estimates that enactment of the Federal Health 
Prisoner Copayment Care Act would result in a reduction of medical 
visits that could be as low as 16 percent and as high as 50 percent. 
That is 50 percent, and that is significant.
  These reductions translate into a real cost savings. The bill would 
generate annual revenues of $500,000 through collection of a copayment 
fee, most of which would benefit crime victims. Additionally, $1 
million to $2 million in cost savings in reduced health care visits 
would be realized and could be upwards of $5 million in subsequent 
years.
  According to CBO, the costs of administering this program would only 
cost about $170,000 annually. There is absolutely no doubt that 
enactment of the Federal Prisoner Health Care Copayment Act will save 
taxpayers money and provide victims of crime with a modest boost in 
funding.
  The bill will also improve prison safety and discipline, promote 
responsibility, and increase the resources available to truly sick 
inmates.

                              {time}  1615

  In addition to reducing unnecessary visits to these facilities 
operated by the Bureau of Prisons, the bill would accomplish the same 
result for Federal inmates under the supervision of the U.S. Marshals 
Service. The U.S. Marshals Service supports the bill for three other 
reasons:
  Number one, equity. If those in a State criminal justice system must 
pay a copayment, so should the Federal inmates housed in the 
institution. Two, liability. With no Federal law on this matter 
governing, some Federal inmates have sued local facilities that have 
perhaps improperly charged them a copayment. Number three, friction. 
The exempt status of Federal inmates foster resentment amongst State 
inmates. As I mentioned, 38 States have passed this. Will it take 50 
States before we finally get on board and follow the leaders?
  As a bonus that will interest local facilities that house Federal 
inmates, the bill will generate hundreds of thousands of dollars. The 
attacks on this bill have one element in common: They are all 
misplaced. Any constitutional concerns do not even pass the most 
liberal laugh test. Thirty-eight States have enacted the copayment 
laws. These States have survived court challenges in at least seven 
States, one being the State of Virginia. The bill does not deprive 
inmates of health care, rather it requires them, when they have 
sufficient funds in their accounts, to pay a modest copayment when 
seeking elective care.
  While it may be true that a majority of Federal inmates do not have 
an exorbitant amount of money in their prison accounts, what expenses 
do they use their discretionary funds for? Their meals are taken care 
of, their exercise is taken care of, their studies are taken care of. 
Prisoners are not paying for room and board. They are not paying for 
television or recreational services. So where do they spend their 
money? In the commissary on such items as cigarettes. The average cost 
of a pack of smokes is double that of the minimum in the Prisoner 
Copayment Act. If prisoners are left with less money to purchase 
products such as cigarettes, I think we could argue they might be 
better off.
  Those concerned that the copayment would hit poorer inmates harder 
than the richer ones, should be happy to know that the bill permits the 
director of the Bureau of Prisons to assess higher fees for more 
affluent inmates. We have been hearing so much about how terrible the 
rich are in this country, so we can stick it to the rich inmates. This 
is a good provision in this bill.
  As for cost effectiveness, a few members of the minority cite a 
California report on its copayment program. This report indicates that 
copayment fees collected may be less than the amount spent 
administering the program. Even if this is the case, the final figure 
as to the cost effectiveness of the California program, which I have 
read the report, it is dubious at best, because they have no kind of 
tracking mechanism to establish exactly where the money has gone or the 
money is collected or any of the cost-benefit analysis, but they are 
leaving out one critical factor: The dollar value of the frivolous 
visits eliminated by the copayment program. With this added to the 
equation, the California program would be a cost saver. But they have 
not had any tracking mechanism instituted to determine any real data on 
that. In any event, CBO has reviewed the legislation before us today 
and concluded that it could save up to $5 million a year in health care 
costs.
  Some argue this will endanger prisoner guards. That obviously is not 
the case, given the strong support of the Federal Bureau of Prisons. In 
fact, just the opposite is the case. Guards may be exposed to 
additional danger when they accompany prisoners en route to a health 
care visit.
  The final argument is the bill would lead to a decline in health care 
services for inmates. Wrong again. What the bill would do is to 
eliminate a significant percentage of frivolous visits. This should 
leave additional funds and resources for the generally infirm inmates.
  The vote today on the Federal Prison Health Care Copayment Act will 
place each Member on one of two sides: The side of convicts or the side 
of victims. I encourage my colleagues to side with the victims.
  Mr. SCOTT. Mr. Speaker, can you advise how much time remains on both 
sides?
  The SPEAKER pro tempore (Mr. Shimkus). The gentleman from Virginia 
(Mr. Scott) has 14 minutes remaining, and the gentleman from Indiana 
(Mr. Pease) has 7\1/2\ minutes remaining.
  The Chair recognizes the gentleman from Virginia (Mr. Scott).
  Mr. SCOTT. Mr. Speaker, I yield myself 2 minutes just to say that, 
first, I could not quite tell on the pictures that were presented 
whether or not Members of Congress were over there pictured with the 
convicts, because we do not pay a copay.
  I would also want to point out that according to the California State 
auditor, when they did their study on their program they made 
projections, and when they looked at what they collected, they only 
collected about one-third of what they had anticipated. So all of these 
projections ought to be taken in that light.
  But it seems to me when we have a program that the State auditor of 
California calculated that they wasted $2.5 million trying to implement 
because the cost of implementation was more than the collections, that 
seems a strange reaction to a situation where we have a grandmother 
that someone is trying to give relief to. It seems to me we could take 
some of that $2.5 million and buy a whole lot of health insurance.
  We talk about reduction in costs. We also have to add back the cost 
of the fact that the infectious diseases may not be caught and other 
people may be infected. Other situations like cancer may not be 
detected earlier when it is easier to treat. These kinds of expenses 
will go up because of this copay.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PEASE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
North Carolina (Mrs. Myrick).

[[Page H7810]]

  Mrs. MYRICK. Mr. Speaker, I rise today in strong support of this bill 
because it is another step toward just plain old common sense in our 
Federal Government.
  Thirty-eight States, as has been mentioned, including my own State of 
North Carolina, have successfully implemented this copayment program to 
help cover the cost of prisoners health care. And there is good reason 
for that. In North Carolina, the average total cost per inmate per day 
is $63. Of that, food costs about $5, but health care costs over $8.50.
  With those numbers in mind, 3 years ago my State decided to implement 
a $3 copayment for medical services. This bill would bring that same 
common sense idea to our Federal prisons. If private citizens must pay 
every time they go to a doctor, then certainly those who have broken 
the law should have to pay when they choose to go to a doctor.
  Yes, this bill will save Federal taxpayers money. CBO says about $5 
million a year. However, it is the crime victims who will reap the most 
benefit from H.R. 1349. Seventy-five percent of the copayments will be 
directed to the Federal crime victims fund. And these copayments mean 
that with each elective visit to the infirmary, prisoners will take 
another small step to paying for their crimes.
  It cannot be stated enough that under no circumstances will emergency 
services, prenatal care, treatment for infectious diseases, mental 
health care or substance abuse treatment be prevented under this bill. 
That will not happen. All of those services will be provided regardless 
of the prisoner's ability to pay. But by requiring nominal copayments 
of our prisoners for elective medical treatments, this Congress will 
enact another common sense reform and, at the same time, give some help 
to the victims of these criminals.
  Mr. SCOTT. Mr. Speaker, I yield myself such time as I may consume 
just to point out that the crime victims who may get money, if we look 
at the cost in administering this program, a $1 copay would cost 33 
cents just to mail the $1 to the victim. Before we have accounted for 
it in collecting, in accounting, and all that kind of stuff, the idea 
that the crime victims may get a benefit, it would be a lot easier and 
cheaper just to appropriate more money directly to crime victims, to 
the crime victims fund.
  This is a total waste of the taxpayers' money. Anybody that knows 
anything about accounting knows that trying to account for these $1 
copays will be much more than any benefit that could be derived.
  Again, Mr. Speaker, in conclusion, I would say the bill violates the 
government's obligation under the Constitution to provide health 
services. It constitutes bad public policy by discouraging the truly 
sick from seeking health care; it hits those who are sick from 
accessing appropriate services, as well as those that are not; and I 
think it is unconscionable to suggest we want to discourage people from 
accessing appropriate health care.
  In the end, this program will cost the taxpayers money, more money 
than they can ever collect from this program. Accordingly, I urge my 
colleagues to vote ``no'' on this bill.
  Mr. Speaker, I have no further requests for time, and I yield back 
the balance of my time.
  Mr. PEASE. Mr. Speaker, I yield myself such time as I may consume, 
and rather than reiterate the statement of the gentleman from Florida 
(Mr. McCollum), which has now been entered in the record, let me just 
mention one point that was made during the debate, and that is the 
assertion that Members of Congress do not copay for their health care.
  While there are a variety of options available, and I am not familiar 
with all of the plans, I know that this Member, and others that I have 
spoken to sitting right here, do copay on our health care plans.
  Mr. Speaker, I would ask for support of the House on the bill.
  Mr. Speaker, I have no further requests for time, and I yield back 
the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Indiana (Mr. Pease) that the House suspend the rules and 
pass the bill, H.R. 1349, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.
  Mr. PEASE. Mr. Speaker, I ask unanimous consent that the Committee on 
the Judiciary be discharged from the further consideration of the 
Senate bill (S. 704) to amend title 18, United States Code, to combat 
the overutilization of prison health care services and control rising 
prisoner health care costs, and ask for its immediate consideration.
  The Clerk read the title of the Senate bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Indiana?
  There was no objection.
  The Clerk read the Senate bill, as follows:

                                 S. 704

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Federal Prisoner Health Care 
     Copayment Act of 1999''.

     SEC. 2. HEALTH CARE FEES FOR PRISONERS IN FEDERAL 
                   INSTITUTIONS.

       (a) In General.--Chapter 303 of title 18, United States 
     Code, is amended by adding at the end the following:

     ``Sec. 4048. Fees for health care services for prisoners

       ``(a) Definitions.--In this section--
       ``(1) the term `account' means the trust fund account (or 
     institutional equivalent) of a prisoner;
       ``(2) the term `Director' means the Director of the Bureau 
     of Prisons;
       ``(3) the term `health care provider' means any person who 
     is--
       ``(A) authorized by the Director to provide health care 
     services; and
       ``(B) operating within the scope of such authorization;
       ``(4) the term `health care visit'--
       ``(A) means a visit, as determined by the Director, 
     initiated by a prisoner to an institutional or 
     noninstitutional health care provider; and
       ``(B) does not include a visit initiated by a prisoner--
       ``(i) pursuant to a staff referral; or
       ``(ii) to obtain staff-approved follow-up treatment for a 
     chronic condition; and
       ``(5) the term `prisoner' means--
       ``(A) any individual who is incarcerated in an institution 
     under the jurisdiction of the Bureau of Prisons; or
       ``(B) any other individual, as designated by the Director, 
     who has been charged with or convicted of an offense against 
     the United States.
       ``(b) Fees for Health Care Services.--
       ``(1) In general.--The Director, in accordance with this 
     section and with such regulations as the Director shall 
     promulgate to carry out this section, may assess and collect 
     a fee for health care services provided in connection with 
     each health care visit requested by a prisoner.
       ``(2) Exclusion.--The Director may not assess or collect a 
     fee under this section for preventative health care services, 
     emergency services, prenatal care, diagnosis or treatment of 
     contagious diseases, mental health care, or substance abuse 
     treatment, as determined by the Director.
       ``(c) Persons Subject to Fee.--Each fee assessed under this 
     section shall be collected by the Director from the account 
     of--
       ``(1) the prisoner receiving health care services in 
     connection with a health care visit described in subsection 
     (b)(1); or
       ``(2) in the case of health care services provided in 
     connection with a health care visit described in subsection 
     (b)(1) that results from an injury inflicted on a prisoner by 
     another prisoner, the prisoner who inflicted the injury, as 
     determined by the Director.
       ``(d) Amount of Fee.--Any fee assessed and collected under 
     this section shall be in an amount of not less than $2.
       ``(e) No Consent Required.--Notwithstanding any other 
     provision of law, the consent of a prisoner shall not be 
     required for the collection of a fee from the account of the 
     prisoner under this section.
       ``(f) No Refusal of Treatment for Financial Reasons.--
     Nothing in this section may be construed to permit any 
     refusal of treatment to a prisoner on the basis that--
       ``(1) the account of the prisoner is insolvent; or
       ``(2) the prisoner is otherwise unable to pay a fee 
     assessed under this section.
       ``(g) Use of Amounts.--
       ``(1) Restitution to specific victims.--Amounts collected 
     by the Director under this section from a prisoner subject to 
     an order of restitution issued pursuant to section 3663 or 
     3663A shall be paid to victims in accordance with the order 
     of restitution.
       ``(2) Allocation of other amounts.--Of amounts collected by 
     the Director under this section from prisoners not subject to 
     an order of restitution issued pursuant to section 3663 or 
     3663A--
       ``(A) 75 percent shall be deposited in the Crime Victims 
     Fund established under section 1402 of the Victims of Crime 
     Act of 1984 (42 U.S.C. 10601); and

[[Page H7811]]

       ``(B) 25 percent shall be available to the Attorney General 
     for administrative expenses incurred in carrying out this 
     section.
       ``(h) Reports to Congress.--Not later than 1 year after the 
     date of enactment of the Federal Prisoner Copayment Act of 
     1999, and annually thereafter, the Director shall submit to 
     Congress a report, which shall include--
       ``(1) a description of the amounts collected under this 
     section during the preceding 12-month period; and
       ``(2) an analysis of the effects of the implementation of 
     this section, if any, on the nature and extent of heath care 
     visits by prisoners.''.
       (b) Clerical Amendment.--The analysis for chapter 303 of 
     title 18, United States Code, is amended by adding at the end 
     the following:

``4048. Fees for health care services for prisoners.''.

     SEC. 3. HEALTH CARE FEES FOR FEDERAL PRISONERS IN NON-FEDERAL 
                   INSTITUTIONS.

       Section 4013 of title 18, United States Code, is amended by 
     adding at the end the following:
       ``(c) Health Care Fees for Federal Prisoners in Non-Federal 
     Institutions.--
       ``(1) In general.--Notwithstanding amounts paid under 
     subsection (a)(3), a State or local government may assess and 
     collect a reasonable fee from the trust fund account (or 
     institutional equivalent) of a Federal prisoner for health 
     care services, if--
       ``(A) the prisoner is confined in a non-Federal institution 
     pursuant to an agreement between the Federal Government and 
     the State or local government;
       ``(B) the fee--
       ``(i) is authorized under State law; and
       ``(ii) does not exceed the amount collected from State or 
     local prisoners for the same services; and
       ``(C) the services--
       ``(i) are provided within or outside of the institution by 
     a person who is licensed or certified under State law to 
     provide health care services and who is operating within the 
     scope of such license;
       ``(ii) constitute a health care visit within the meaning of 
     section 4048(a)(4) of this title; and
       ``(iii) are not preventative health care services, 
     emergency services, prenatal care, diagnosis or treatment of 
     contagious diseases, mental health care, or substance abuse 
     treatment.
       ``(2) No refusal of treatment for financial reasons.--
     Nothing in this subsection may be construed to permit any 
     refusal of treatment to a prisoner on the basis that--
       ``(A) the account of the prisoner is insolvent; or
       ``(B) the prisoner is otherwise unable to pay a fee 
     assessed under this subsection.''.


                      Motion Offered by Mr. Pease

  Mr. PEASE. Mr. Speaker, I offer a motion.
  The Clerk read as follows:

       Mr. Pease moves to strike out all after the enacting clause 
     of the Senate bill, S. 704, and insert in lieu thereof the 
     text of H.R. 1349, as passed the House.

  The motion was agreed to.
  The Senate bill was ordered to be read a third time, was read the 
third time, and passed, and a motion to reconsider was laid on the 
table.
  A similar House bill (H.R. 1349) was laid on the table.

                          ____________________