Congressional Record, Volume 146 Issue 111 (Tuesday, September 19, 2000)

[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

[[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.

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