[House Report 106-851]
[From the U.S. Government Publishing Office]
106th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 106-851
======================================================================
FEDERAL PRISONER HEALTH CARE COPAYMENT ACT OF 2000
_______
September 14, 2000.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. McCollum, from the Committee on the Judiciary, submitted the
following
R E P O R T
together with
DISSENTING VIEWS
[To accompany H.R. 1349]
[Including cost estimate of the Congressional Budget Office]
The Committee on the Judiciary, to whom was referred 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, having considered
the same, reports favorably thereon with an amendment and
recommends that the bill as amended do pass.
TABLE OF CONTENTS
Page
The Amendment.............................................. 2
Purpose and Summary........................................ 4
Background and Need for the Legislation.................... 5
Hearings................................................... 6
Committee Consideration.................................... 6
Vote of the Committee...................................... 6
Committee Oversight Findings............................... 8
Committee on Government Reform Findings.................... 8
New Budget Authority and Tax Expenditures.................. 9
Congressional Budget Office Cost Estimate.................. 9
Constitutional Authority Statement......................... 12
Section-by-Section Analysis and Discussion................. 12
Agency Views............................................... 15
Changes in Existing Law Made by the Bill, as Reported...... 15
Dissenting Views........................................... 21
Additional Dissenting Views................................ 23
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
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;
``(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.''.
(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.''.
SEC. 4. COMPREHENSIVE HIV/AIDS SERVICES REQUIRED TO BE INCLUDED IN
HEALTH CARE SERVICES FOR WHICH HEALTH CARE FEES MAY
BE ASSESSED.
Any health care services for which a person may be assessed a fee
under section 4048 of title 18, United States Code (as added by section
2) or section 4013(c) of such title (as added by section 3) shall
include comprehensive coverage for services relating to human
immunodeficiency virus (HIV) and acquired immune deficiency syndrome
(AIDS).
Purpose and Summary
H.R. 1349, the ``Federal Prisoner Health Care Copayment Act
of 2000,'' authorizes the Federal Bureau of Prisons to collect
a fee from any person who has been charged with or convicted of
a Federal crime each time that person visits a health care
professional at his or her request and receives health care
services. The amount of the fee is to be determined by the
Director of the Bureau of Prisons through regulation, but would
be at least $1 per visit. The fee would be assessed and
deducted from any account maintained on behalf of the prisoner
receiving the services. The fee would not be assessed or
collected for preventative health care services, emergency
services, prenatal care, diagnosis or treatment for chronic
infectious diseases, mental health care, or substance abuse
treatment. The bill further provides that when a Federal
prisoner is housed in a non-Federal facility (e.g., pursuant to
an agreement between the Federal Government and a State or
local government) the State or local facility may assess a fee
for health care services, provided that such a fee is
authorized under the law of the State where the Federal
prisoner is housed and that State prisoners are charged no
greater a fee.
Background and Need for the Legislation
H.R. 1349 amends title 18 of the United States Code to
authorize the Director of the Bureau of Prisons (BOP) to assess
and collect a fee from prisoners for health care services
provided to them. The intent of the bill is to impose a type of
``copayment fee'' of a nominal amount on prisoners, similar to
the nominal fee paid by many Americans when they visit a health
care provider under a managed health care plan.
Currently, inmates incarcerated in the Federal prison
system and persons who are detained pending trial receive free
medical care from BOP employees (physicians, physician
assistants, and nurses) and Public Health Service (PHS)
personnel (generally physician assistants, dentists, and
pharmacists) assigned to each institution. Additionally, the
BOP maintains contracts with medical specialists in private
practice who provide care that cannot be provided by the BOP
employees and PHS personnel. For the most seriously ill
inmates, the BOP operates seven Federal Medical Centers at
which are located fully accredited hospitals and facilities to
care for long-term chronically and terminally ill inmates. In
fiscal year 1999, the BOP spent $372.1 million in health care
costs.\1\
---------------------------------------------------------------------------
\1\ Federal Prisons: Containing Health Care Costs for an Increasing
Inmate Population, No. GAO/T-GGD-00-112, at 3 (April 6,
2000)(hereinafter ``GAO Report'').
---------------------------------------------------------------------------
All inmates \2\ in the BOP system are required to work if
medically able, and all who work are paid for their labor.\3\
Persons detained while awaiting trial are not required to work.
Wages paid to inmates are retained in an inmate account, which
inmates can use to pay for telephone calls and purchases from
the prison commissary. A prisoner's family may deposit money
into his or her account for his or her use as well.
---------------------------------------------------------------------------
\2\ In this report, the term ``inmate'' is used to describe a
person who has been convicted of a Federal crime and has been
incarcerated for that offense, while the term ``prisoner'' is used to
describe both inmates as well as persons who are detained pending
trial.
\3\ Approximately, 75% of BOP inmates are paid between 12 cents and
40 cents per hour, with the majority of BOP inmates making less than 17
cents per hour. The highest paid inmates make approximately $1.15 per
hour.
---------------------------------------------------------------------------
At a hearing on H.R. 1349 held by the Subcommittee on
Crime, a representative of the Bureau of Prisons testified that
some portion of the inmates who seek medical treatment at any
given time do so for the purpose of avoiding work or other
rehabilitative programming which is imposed on them. Inmates
know that while they are waiting for treatment they are excused
from all programming. Inmates who seek treatment without a
legitimate medical complaint waste the time of medical staff
and force truly sick inmates to wait to receive the care they
need. The BOP supports imposing a nominal health care co-
payment fee on all prisoners for the same reason that managed
health care plans impose them on their customers, namely, it
will help deter overuse of health care services (i.e., use of
those services by people who do not really need them).
A recent General Accounting Office report found that co-
payment fees for prison inmates have been adopted in 36
States.\4\ Among States and localities that have imposed these
fees, reductions in sick call visits of from 16 to 50 percent
have been realized. In its report, the GAO concluded that use
of a health care co-payment fee system would reduce the number
of unnecessary medical visits in the Federal prison system,
perhaps reducing overall visits by as much as 25 percent.\5\
---------------------------------------------------------------------------
\4\ GAO Report, at 3.
\5\ Id. at 12.
---------------------------------------------------------------------------
Hearings
The committee's Subcommittee on Crime held 1 day of
hearings on H.R. 1349 on September 30, 1999. Testimony was
received from 3 witnesses, representing 2 organizations. No
additional material was submitted.
Committee Consideration
On March 16, 2000, the Subcommittee on Crime met in open
session and ordered favorably reported the bill H.R. 1349, as
amended, by a voice vote, a quorum being present. On July 19,
2000, the committee met in open session and ordered favorably
reported the bill H.R. 1349 with an amendment by voice vote, a
quorum being present.
Vote of the Committee
Rollcall No. 1 (6/27/00). Mr. Scott offered an amendment to
prohibit the assessment and collection of a fee for health care
services if prisoners have a ``reasonable basis'' for seeking
health care services. By a rollcall vote of 9 yeas to 14 nays,
the amendment was defeated.
ROLLCALL NO. 1
----------------------------------------------------------------------------------------------------------------
Ayes Nays Present
----------------------------------------------------------------------------------------------------------------
Mr. Sensenbrenner............................................... .............. X ..............
Mr. McCollum.................................................... .............. .............. ..............
Mr. Gekas....................................................... .............. X ..............
Mr. Coble....................................................... .............. X ..............
Mr. Smith (TX).................................................. .............. X ..............
Mr. Gallegly.................................................... .............. .............. ..............
Mr. Canady...................................................... .............. X ..............
Mr. Goodlatte................................................... .............. X ..............
Mr. Chabot...................................................... .............. .............. ..............
Mr. Barr........................................................ .............. .............. ..............
Mr. Jenkins..................................................... .............. .............. ..............
Mr. Hutchinson.................................................. .............. X ..............
Mr. Pease....................................................... .............. .............. ..............
Mr. Cannon...................................................... .............. .............. ..............
Mr. Rogan....................................................... .............. X ..............
Mr. Graham...................................................... .............. .............. ..............
Ms. Bono........................................................ .............. X ..............
Mr. Bachus...................................................... .............. X ..............
Mr. Scarborough................................................. .............. .............. ..............
Mr. Vitter...................................................... .............. X ..............
Mr. Conyers..................................................... X .............. ..............
Mr. Frank....................................................... .............. .............. ..............
Mr. Berman...................................................... X .............. ..............
Mr. Boucher..................................................... .............. .............. ..............
Mr. Nadler...................................................... X .............. ..............
Mr. Scott....................................................... X .............. ..............
Mr. Watt........................................................ X .............. ..............
Ms. Lofgren..................................................... X .............. ..............
Ms. Jackson Lee................................................. X .............. ..............
Ms. Waters...................................................... X .............. ..............
Mr. Meehan...................................................... .............. .............. ..............
Mr. Delahunt.................................................... .............. .............. ..............
Mr. Wexler...................................................... .............. .............. ..............
Mr. Rothman..................................................... .............. X ..............
Ms. Baldwin..................................................... X .............. ..............
Mr. Weiner...................................................... .............. X ..............
Mr. Hyde, Chairman.............................................. .............. X ..............
-----------------------------------------------
Total....................................................... 9 14 ..............
----------------------------------------------------------------------------------------------------------------
Rollcall No. 2 (7/19/00). Mr Scott offered an amendment to
delete the word ``chronic'' with respect to the prohibition on
collecting a health care services fee for the treatment of
chronic infectious diseases. By a rollcall vote of 9 yeas to 20
nays, the amendment was defeated.
ROLLCALL NO. 2
----------------------------------------------------------------------------------------------------------------
Ayes Nays Present
----------------------------------------------------------------------------------------------------------------
Mr. Sensenbrenner............................................... .............. X ..............
Mr. McCollum.................................................... .............. X ..............
Mr. Gekas....................................................... .............. X ..............
Mr. Coble....................................................... .............. X ..............
Mr. Smith (TX).................................................. .............. X ..............
Mr. Gallegly.................................................... .............. X ..............
Mr. Canady...................................................... .............. X ..............
Mr. Goodlatte................................................... .............. X ..............
Mr. Chabot...................................................... .............. X ..............
Mr. Barr........................................................ .............. X ..............
Mr. Jenkins..................................................... .............. X ..............
Mr. Hutchinson.................................................. .............. X ..............
Mr. Pease....................................................... .............. .............. ..............
Mr. Cannon...................................................... .............. X ..............
Mr. Rogan....................................................... .............. X ..............
Mr. Graham...................................................... .............. X ..............
Ms. Bono........................................................ .............. .............. ..............
Mr. Bachus...................................................... .............. X ..............
Mr. Scarborough................................................. .............. X ..............
Mr. Vitter...................................................... .............. X ..............
Mr. Conyers..................................................... X .............. ..............
Mr. Frank....................................................... X .............. ..............
Mr. Berman...................................................... X .............. ..............
Mr. Boucher..................................................... .............. .............. ..............
Mr. Nadler...................................................... X .............. ..............
Mr. Scott....................................................... X .............. ..............
Mr. Watt........................................................ .............. .............. ..............
Ms. Lofgren..................................................... X .............. ..............
Ms. Jackson Lee................................................. .............. .............. ..............
Ms. Waters...................................................... X .............. ..............
Mr. Meehan...................................................... .............. .............. ..............
Mr. Delahunt.................................................... .............. .............. ..............
Mr. Wexler...................................................... .............. .............. ..............
Mr. Rothman..................................................... .............. X ..............
Ms. Baldwin..................................................... X .............. ..............
Mr. Weiner...................................................... X .............. ..............
Mr. Hyde, Chairman.............................................. .............. X ..............
-----------------------------------------------
Total....................................................... 9 20 ..............
----------------------------------------------------------------------------------------------------------------
Rollcall No. 3 (7/19/00). Mr. Scott offered an amendment to
strike that portion of the bill that authorizes State and local
governments to assess and collect a health care services fee
from Federal prisoners housed in non-Federal institutions in
certain circumstances. By a rollcall vote of 7 yeas to 21 nays,
the amendment was defeated.
ROLLCALL NO. 3
----------------------------------------------------------------------------------------------------------------
Ayes Nays Present
----------------------------------------------------------------------------------------------------------------
Mr. Sensenbrenner............................................... .............. X ..............
Mr. McCollum.................................................... .............. X ..............
Mr. Gekas....................................................... .............. X ..............
Mr. Coble....................................................... .............. X ..............
Mr. Smith (TX).................................................. .............. X ..............
Mr. Gallegly.................................................... .............. .............. ..............
Mr. Canady...................................................... .............. X ..............
Mr. Goodlatte................................................... .............. X ..............
Mr. Chabot...................................................... .............. X ..............
Mr. Barr........................................................ .............. X ..............
Mr. Jenkins..................................................... .............. X ..............
Mr. Hutchinson.................................................. .............. X ..............
Mr. Pease....................................................... .............. .............. ..............
Mr. Cannon...................................................... .............. X ..............
Mr. Rogan....................................................... .............. X ..............
Mr. Graham...................................................... .............. X ..............
Ms. Bono........................................................ .............. .............. ..............
Mr. Bachus...................................................... .............. X ..............
Mr. Scarborough................................................. .............. X ..............
Mr. Vitter...................................................... .............. X ..............
Mr. Conyers..................................................... X .............. ..............
Mr. Frank....................................................... X .............. ..............
Mr. Berman...................................................... .............. .............. ..............
Mr. Boucher..................................................... .............. .............. ..............
Mr. Nadler...................................................... X .............. ..............
Mr. Scott....................................................... X .............. ..............
Mr. Watt........................................................ .............. .............. ..............
Ms. Lofgren..................................................... X .............. ..............
Ms. Jackson Lee................................................. .............. .............. ..............
Ms. Waters...................................................... X .............. ..............
Mr. Meehan...................................................... .............. X ..............
Mr. Delahunt.................................................... .............. .............. ..............
Mr. Wexler...................................................... .............. .............. ..............
Mr. Rothman..................................................... .............. X ..............
Ms. Baldwin..................................................... X .............. ..............
Mr. Weiner...................................................... .............. X ..............
Mr. Hyde, Chairman.............................................. .............. X ..............
-----------------------------------------------
Total....................................................... 7 21 ..............
----------------------------------------------------------------------------------------------------------------
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII of the Rules
of the House of Representatives, the committee reports that the
findings and recommendations of the committee, based on
oversight activities under clause 2(b)(1) of rule X of the
Rules of the House of Representatives, are incorporated in the
descriptive portions of this report.
Committee on Government Reform Findings
No findings or recommendations of the Committee on
Government Reform were received as referred to in clause
3(c)(4) of rule XIII of the Rules of the House of
Representatives.
New Budget Authority and Tax Expenditures
Clause 3(c)(2) of House Rule XIII is inapplicable because
this legislation does not provide new budgetary authority or
increased tax expenditures.
Congressional Budget Office Cost Estimate
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, the committee sets forth, with
respect to the bill, H.R. 1349, the following estimate and
comparison prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, August 3, 2000.
Hon. Henry J. Hyde, Chairman,
Committee on the Judiciary,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1349, the Federal
Prisoner Health Care Copayment Act of 2000.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Lanette J.
Keith (for federal costs), who can be reached at 226-2860,
Shelley Finlayson (for the state and local impact), who can be
reached at 225-3220, and John Harris (for the private-sector
impact), who can be reached at 226-2618.
Sincerely,
Dan L. Crippen, Director.
Enclosure
cc:
Honorable John Conyers Jr.
Ranking Democratic Member
H.R. 1349--Federal Prisoner Health Care Copayment Act of 2000.
SUMMARY
Enacting H.R. 1349 would permit the Bureau of Prisons (BOP)
to assess and collect a copayment fee of at least $1 for each
health care visit initiated by a prisoner (excluding those for
preventative health care services, emergency services, prenatal
care, treatment of chronic infectious diseases, mental health,
or substance abuse services). Fees collected from prisoners who
are subject to an order of restitution would be paid to
victims. Of the remaining fees, 75 percent would be deposited
into the Crime Victims Fund and 25 percent would be available
to the Attorney General for spending on administrative expenses
incurred in carrying out the copayment program.
CBO expects that imposing such fees would reduce the demand
for health care services from federal prisoners. We estimate
that the reduction in demand would result in net savings of
less than $5 million annually over the 2001-2005 period,
assuming that future appropriations are reduced to reflect the
lower health care costs. Also, we estimate that the proposed
health care copayment would generate about $2 million in
offsetting receipts (a credit against direct spending) over the
2001-2005 period. Those collections would be available for
spending without appropriation action. CBO expects that there
would be a lag between the collection and the spending of such
receipts, but we estimate that the net change in direct
spending would be less than $500,000 a year. Because enacting
this bill would affect direct spending, pay-as-you-go
procedures would apply.
H.R. 1349 contains no intergovernmental mandates as defined
in that Unfunded Mandates Reform Act (UMRA) and would impose no
costs on state, local, or tribal governments. H.R. 1349 would
impose a new private sector-mandate, but CBO estimates that the
direct cost of the mandate would fall well below the annual
threshold established in UMRA ($109 million in 2000, adjusted
annually for inflation).
ESTIMATED COST TO THE FEDERAL GOVERNMENT
Collecting and spending the copayment fees under H.R. 1349
would constitute direct spending, but have no significant net
budgetary impact. The reduction in demand for health care
services that would likely stem from imposing those copayments
would in turn reduce the need for discretionary appropriations.
CBO estimates that potential savings would be less than $5
million a year.
Direct Spending
Based on information from the BOP, CBO estimates that under
this bill, about 400,000 health care visits by prisoners in
federal prisons would be subject to a $1 fee in fiscal year
2001. We estimate some indigent prisoners could not pay the
fee, and that assessing such a fee would deter some prisoners
from initiating some visits, but we also expect that the
overall prison population will continue to increase each year.
Assuming that the bill would reduce nonpreventative health care
visits by between 10 percent and 25 percent, and that the
prison population will increase by about 10 percent annually,
CBO estimates that about $350,000 in copayments would be
collected each year. Most or all such amounts would be spent,
resulting in little or no net budgetary impact.
Spending Subject to Appropriation
Based on the results of programs in some states that
require health care copayments from prisoners, CBO expects that
the copayment program would reduce the number of health care
visits initiated by prisoners. As a result, the BOP would
realize some savings in health care costs. Savings would not be
directly proportionate to the reduction in the number of visits
because much of the BOP's $350 million annual spending on
health services would not be affected by this reduction. In
addition, CBO estimates that the BOP would spend about $170,000
a year to administer the copayment program and only about half
of such costs would be offset by the portion of collections
made available to the Attorney General.
CBO estimates that net savings of about $1 million could be
realized in fiscal year 2001. Savings could be as high as $5
million annually in subsequent years because some costs that
are fixed in the near term might be eliminated in future years.
Savings in health care services would be realized only to the
extent that appropriations were reduced accordingly.
PAY-AS-YOU-GO CONSIDERATIONS
The Balanced Budget and Emergency Deficit Control Act sets
up pay-as-you-go procedures for legislation affecting direct
spending and receipts. H.R. 1349 would affect direct spending,
but CBO estimates that the net changes in direct spending
(accounting for some lag between collections and spending)
would be less than $500,000 a year.
ESTIMATED IMPACT ON STATE, LOCAL, AND TRIBAL GOVERNMENTS
H.R. 1349 contains no intergovernmental mandates as defined
in UMRA and would impose no costs on state, local, or tribal
governments. Under certain circumstances, the bill would allow
state and local correctional institutions to charge federal
prisoners in their facilities a copayment for certain health
care services. While the fees charged by these institutions
vary, CBO estimates that total receipts to state and local
governments would increase by less than $400,000 per year.
ESTIMATED IMPACT ON THE PRIVATE SECTOR
H.R. 1349 would create a new private-sector mandate by
requiring federal prisoners to make copayments for some health
care visits. Based on data from the Bureau of Prisons, CBO
estimates that prisoners in federal facilities would pay about
$350,000 annually in such fees. Federal prisoners housed in
state or local institutions would also be required to pay fees
in cases where those institutions choose to charge them; such
fees would amount to less than $400,000 annually over the next
five years. CBO therefore expects that the direct cost of the
federal mandate would be well below the annual threshold
established in UMRA ($109 million in 2000, adjusted for
inflation) for any of the first five years that the mandate is
in effect.
PREVIOUS CBO ESTIMATE
On May 25, 1999, CBO transmitted a cost estimate for S.
704, the Federal Prisoner Health Care Copayment Act of 1999, as
reported by the Senate Committee on the Judiciary on April 29,
1999. S. 704 would set the minimum copay charge for health
services in federal prisons at $2 per visit. H.R. 1349 would
set the minimum charge at $1 per visit, and our cost estimates
reflect this difference.
ESTIMATE PREPARED BY:
Federal Costs: Lanette J. Keith (226-2860)
Impact on State, Local, and Tribal Governments: Shelley
Finlayson (225-3220)
Impact on the Private Sector: John Harris (226-2618)
ESTIMATE APPROVED BY:
Peter H. Fontaine
Deputy Assistant Director for Budget Analysis
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the committee finds the authority for
this legislation in Article I, section 8, clause 18 of the
Constitution.
Section-by-Section Analysis and Discussion
Sec. 1. Short Title. Section 1 of the bill states the short
title of the act as the ``Federal Prisoner Health Care
Copayment Act of 2000.''
Section 2. Health Care Fees for Prisoners in Federal
Institutions. Section 2 of the bill enacts new section 4048 to
title 18 of the United States Code. New section 4048 authorizes
the collection of a fee for health care services from persons
in the custody of the Bureau of Prisons or who have been
charged with or convicted of an offense against the United
States. Thus, the fee may be assessed and collected from
persons awaiting trial as well as from convicted offenders.
Under new section 4048, the Director of the Bureau of
Prisons is authorized to assess and collect a fee for health
care services provided to a prisoner. The amount of the fee is
to be determined by the Director pursuant to regulations
promulgated by her, but in no event may the fee be less than
$1. The committee understands that the Director plans to
establish a sliding scale of fees that take into account a
prisoner's ability to pay the fee assessed.
The fee is to be assessed and collected with respect to
each ``health care visit,'' which is defined in the bill to
mean any visit to a health care provider, but not visits
initiated by a prisoner pursuant to a staff referral or to
obtain staff-approved follow-up treatment for a chronic
condition. The bill also provides that no fee is to be assessed
or collected for preventative health care services, emergency
services, prenatal care, diagnosis or treatment for chronic
infectious diseases, mental health care, or substance abuse
treatment. The Director is to determine which specific health
care treatments fall into these broad categories. In the event
that an inmate receives health care services as a result of an
injury inflicted on that prisoner by another prisoner, the bill
requires that the prisoner who inflicted the injury is to be
assessed the fee that otherwise would have been assessed
against the prisoner receiving the health care services.
Fees assessed under this section are to be collected by the
Director from the account of the prisoner receiving the health
care services. However, a prisoner may not be refused health
care services solely on the basis that the prisoner's inmate
account is insolvent or that the prisoner is otherwise unable
to pay a fee assessed under this section. The committee expects
that when medically appropriate, health care services will be
provided to all prisoners regardless of their ability to pay
the fee required under section 4048.
Subsection (e) of new section 4048 requires that prisoners
be given a reasonable opportunity to dispute the amount of the
fee and to dispute whether the prisoner qualifies under an
exclusion set forth in section 4048. The committee notes that
the Bureau of Prisons has an existing administrative remedy
process whereby prisoners may raise grievances and request
official action. The committee expects that prisoners will use
this procedure to raise issues under subsection (e) of section
4048. If so, that process satisfies the requirements of
subsection (e).
Subsection (g) of section 4048 provides for the manner in
which health care fees collected under that section are to be
used. If a fee is collected from a prisoner who is subject to
an order of restitution, the amount collected is to be paid to
the prisoner's victim or victims in accordance with that order.
Of the fees collected from prisoners who are not subject to
restitution orders, 75% of those fees collected are to be
deposited in he Federal Crime Victims Fund and 25% are to be
made available to the Attorney General to be used to offset the
administrative expenses incurred in carrying out the
requirements of section 4048.
Subsection (h) of new section 4048 requires that all
prisoners receive written and oral notice of the provisions of
section 4048 before any fee is collected from them under it.
That subsection also prohibits the collection of such a fee
from a prisoners until 30 days after date on which the prisoner
receives the notices. This provision simply prohibits the
assessment or collection of the fee authorized under this act
during that 30 day period. The committee expects that medically
appropriate health care services will continue to be provided
during this period, notwithstanding the fact that no fee may be
assessed.
Subsection (i) provides that any regulations promulgated by
the Director of the Bureau of Prisons implementing the
provisions of section 4048 may not take effect for 30 days
after the date on which all prisoners in the prison system are
provided with written and oral notice of the provisions of the
regulations, or any amendments to them, as the case may be. The
subsection also prohibits the assessment or collection of any
fee under section 4048 for health care services provided within
the 30 day period after notice of the regulations (or
amendments to them) are given to prisoners. In the case of
amendments, this subsection should not be interpreted to mean
that no fee may be assessed during the 30 day period, but
rather that no increase in the fees to be collected resulting
from the amendment may be assessed or collected for services
performed during the 30 day period. Fees may still be assessed
and collected during that period in accordance with the
regulations then in effect during that period.
Subsection (j) of new section 4048 requires that prior to
the start of any period in which the public may comment on
regulations implementing section 4048, or amendments to them,
the Director of the Bureau of Prisons must give notice of the
proposed regulation to each prisoner subject to the regulation
and to groups that advocate on behalf of Federal prisoners.
With respect to advocacy groups, the committee intends that
this notice requirement be deemed satisfied if the Director
mails a copy of the proposed regulations or amendments thereto
to the national headquarters office of the following
organizations: the American Civil Liberties Union, Justice
Fellowship, and Citizens United for the Rehabilitation of
Errants, or any successor organization to them.
Section 4048 also requires the BOP Director to submit
annual reports to Congress concerning the implementation of
section 4048, including the amounts collected under that
section, the cost of administering it, and an analysis of the
effects of the section on the nature and extent of health care
visits by prisoners. Section 4048 also defines certain terms
used in the new section, including ``prisoner,'' ``health care
visit,'' and ``health care provider.''
Section 3. Health Care Fees for Federal Prisoners in Non-
Federal Institutions. Section 3 amends existing section 4013 of
title 18 (relating to support of Federal prisoners in non-
Federal institutions) by adding new subsection (c) to that
section.
New subsection (c) of section 4013 authorizes a State or
local government to assess and collect a reasonable fee from a
Federal prisoner for health care services provided to that
prisoners when the prisoner is confined in a non-Federal
institution pursuant to an agreement between the Federal
Government and the State or local government, such a fee is
authorized to be collected under the law of the State in which
the Federal prisoners is housed, and the fee does not exceed
that collected from State or local prisoners for the same
services. Unlike the fee to be collected under section 4048,
the bill does not require that any minimum fee be assessed and
collected. The fee may only be assessed and collected for
health care services that are provided by health care providers
who are licensed or certified under State law, that constitute
a ``health care visit'' under new section 4048, and that are
not the types of services described in subsection (b)(2) of new
section 4048. As in the case of fees assessed under section
4048, health care services may not be withheld under section
4013(c) if the prisoner's account from which the fee would be
deducted is insolvent, or if the prisoner is otherwise unable
to pay the fee assessed.
As in the case of fees to be assessed under section 4048,
Federal prisoners in State or local facilities must also be
provided with 30 days oral and written notice of the fee to be
imposed under section 4013(c). The State or local government is
not required to provide this notice to prisoners other than
those who are Federal prisoners, and thus subject to section
4013(c). If a State or local government promulgates regulations
or other written guidance to implement section 4013(c), 30 days
notice of the provisions of those regulations, and any
amendments thereto, must be given to a prisoners before a fee
under section 4013 may be assessed against him or her. In the
case of amendments, the provision should not be interpreted to
mean that no fee may be assessed during the 30 day notice
period, but rather that no increase in the fees to be collected
resulting from an amendment may be assessed or collected for
services performed during the 30 day notice period. As in the
case with section 4048, in no event may a State refuse to treat
a Federal prisoner on the basis that the prisoner's inmate
account is insolvent or that the prisoner is otherwise unable
to pay the fee to be assessed under section 4013.
Section 4. Comprehensive HIV/AIDS Services Required to be
Included in Health Care Services for Which Health Care Fees May
Be Assessed. Section 4 of the bill requires that as a condition
of assessing fees under section 4048 or 4013(c), the Director
of the Bureau of Prisons, or the State or local government, as
the case may be, must ensure that comprehensive coverage for
services relating to the virus known as HIV and the condition
known as AIDS is included as part of the total program of heath
care services provided to Federal prisoners. The committee
notes that the Bureau of Prisons currently provides medically
appropriate treatment for the virus and the syndrome that
results from it and that, absent changes in the standard of
care generally accepted by the medical community for HIV and
AIDS, no additional treatment need be provided by the Bureau of
Prisons to impose the fee authorized under section 4048.
Agency Views
U.S. Department of Justice,
Office of Legislative Affairs,
Washington, DC, May 24, 1999.
Hon. Matt Salmon,
House of Representatives, Washington, DC.
Dear Congressman Salmon: Thank you for requesting our views
on H.R. 1349, the ``Federal Prisoner Health Care Copayment
Act.'' The Department of Justice strongly supports allowing
federal prisoners to pay fees for certain medical services. We
do, however, recommend that the terminology in Section 3 of the
bill be clarified so that it is consistent with Section 2 of
the bill. We would recommend that language be added similar to
that in the substitute amendment adopted by the Senate
Judiciary Committee.
Thank you again for the opportunity to comment on this
important legislation. Please do not hesitate to contact us if
we may be of further assistance. The Office of Management and
Budget has advised that it has no objection to submission of
this letter from the standpoint of the Administration's
program.
Sincerely,
Jon P. Jennings, Acting Assistant Attorney General.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
TITLE 18, UNITED STATES CODE
* * * * * * *
PART III--PRISONS AND PRISONERS
* * * * * * *
CHAPTER 301--GENERAL PROVISIONS
* * * * * * *
Sec. 4013. Support of United States prisoners in non-Federal
institutions
(a) * * *
* * * * * * *
(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.
* * * * * * *
CHAPTER 303--BUREAU OF PRISONS
Sec.
4041. Bureau of Prisons; director and employees.
* * * * * * *
4048. Fees for health care services for prisoners.
* * * * * * *
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;
(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.
* * * * * * *
Dissenting Views
H.R. 1349, as amended authorizes the Bureau of Prisons
(BOP) to assess and collect a fee from inmates for health care
services provided to the inmate during a health care visit. The
bill provides for the Director of the BOP to set the fee per
visit, but further provides that it shall be in an amount not
less than one dollar. H.R. 1349 prohibits an assessment for
preventative health care services, staff referrals, staff
approved follow-up treatment, emergency visits, prenatal care,
diagnosis or treatment of chronic infectious diseases, mental
health care, or substance abuse treatment, and further provides
that BOP cannot refuse treatment to an inmate because of an
inability to pay the designated fee. Funds collected under this
bill are to be used to pay victim restitution. If there is no
order of restitution, 75% goes to the Crime Victims Fund and
25% is available to BOP to defer administrative expense of the
program.
The Supreme Court has recognized the government's
obligation to provide health care. The U.S. Supreme Court, in
Estelle v. Gamble \1\ enunciated the principle that the
government has an obligation to provide medicare to prisoners
and this principle has been upheld in subsequent cases \2\. In
DeShaney v. Winnebago County DSS, the court stated:
---------------------------------------------------------------------------
\1\ 429 U.S. 97 (1976)
\2\ DeShaney v. Winnebago County DSS, 489 U.S. 189 (1989)
When the State 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,
clothing, shelter, medical care, and reasonable
safety--it transgresses the substantive limits on State
actions set by the eight amendment and the due process
clause.\3\
---------------------------------------------------------------------------
\3\ Ibid at 199-200.
Given the limited amounts of money on hand in federal
prisoner accounts at any given time, a health care co-payment
requirement may impede their access to needed health care,
particularly at the early treatment and intervention stage. BOP
acknowledges that 75% of BOP inmates are paid between 12 cents
and 40 cents per hour, with the majority of BOP inmates making
less than 17 cents per hour. Further, BOP reports that more
than half of all BOP inmates have no more than $60 in their
accounts at any time, including the day immediately after their
monthly pay period. Thus, even a minor co-pay would constitute
a significant burden on them. Establishing such a prerequisite
to health care treatment not only undermines the federal
government's obligation to provide medical care to inmates, as
discussed in DeShaney, it constitutes bad public policy. An
inmate's failure to get timely treatment could result in minor
problems becoming major problems, such as the spread of
untreated infectious diseases.
There is also a significant question as to whether the cost
of administering the program will be greater than any savings
it projects. Proponents of the legislation point to States
which have instituted inmate health care co-payments to suggest
that co-pays work to discourage unnecessary use of health care
services and save the States money without jeopardizing the
health of inmates. However, this information appears anecdotal
at best. The only study of the issue anyone has been able to
identify is a study by the California State Auditor. This study
found that the California Department of Corrections' annual co-
pay program collections amounted to less than \1/3\ ($654,000)
of the estimated annual collections ($1.7 million) and that the
estimated annual cost of administering the program ($3.2
million) amounted to almost five times the annual collections.
In addition, the proponents' argument that a co-pay will
deter inmate abuse of health care services lacks merit.
Obviously, inmates with substantial amounts of money on account
will not be deterred by a dollar or so co-pay from seeking
unnecessary health care and inmates have to pay a co-pay even
if they are sick. Therefore, the more likely effect of H.R.
1349 is that ability to pay will be the determining factor as
to whether inmates seek health care, not whether the prisoner
truly needs medical attention. Thus, it was not surprising when
the BOP witness acknowledged at the hearing on H.R. 1349 that
there is no way to know how many truly sick inmates would be
deterred because of the cost, as opposed to those abusing the
system. Furthermore, since even those that are determined to be
truly sick must pay, it appears that the real purpose of the
bill is to simply deter inmates from seeking health care,
regardless of whether they need it or not. Consistent with this
goal, the majority opposed amendments which would require a co-
payment only if the inmate is found to have had no reasonable
basis for seeking health care services.
In conclusion, this bill will likely result in inmates
having to choose between needed health care services and other
crucial needs, and in more, as opposed to less, cost to
taxpayers.
John Conyers, Jr.
Barney Frank.
Howard L. Berman.
Robert C. Scott.
Melvin L. Watt.
Zoe Lofgren.
Maxine Waters.
Additional Dissenting Views
In addition to the concerns raised in our dissenting views,
we would also like to note that the sponsors of this bill have
argued that, if prisoners can pay for their health care, they
should. They argue that taxpayers should not be subsidizing
prisoners health care. Our concern is this sets up a double
standard. If we are concerned about wasteful, taxpayer-
supported health care subsidies, we should be asking: What
about Members of Congress?
One floor down from the committee offices, we have a nurse
on call whenever the House is in session. We receive medical
attention, treatment and medicine for a small yearly fee, the
rest of the expense is paid by the taxpayers.
Because of this discrepancy, at the committee markup, we
offered an amendment requiring that Members of Congress pay a
health care copay, in keeping with the Congressional
Accountability Act that made Congress live by the laws it
passes. The majority raised a point of order against the
amendment and refused to even debate it. This was unfortunate.
Why should a Member of Congress get medical evaluation
compensated by taxpayers? Why should a Member of Congress get
Tylenol without paying the same amount as working American
families? Why should the taxpayer be any less concerned about
subsidizing the health care of Members of Congress, who earn
more than $100,000 a year, than they are about prisoners, who
earn less than 50 cents an hour?
This double standard is yet another reason why we have
expressed concerns about the underlying legislation.
John Conyers, Jr.
Maxine Waters.