Researchers have found that higher copays for health care obstruct access to receiving care behind bars, even as prison populations in Mississippi and nationwide face increasing rates of physical and mental health conditions.
One in 10 people with at least one chronic condition in state and federal prisons had not been seen by a clinician since they were incarcerated.
Wanda Bertram, communication strategist for the Prison Policy Initiative, said the copays are often less than $7 but they represent massive barriers to health care.
"If you want to be seen, you have to pay, typically anywhere from $2 to $5, or in the case of Mississippi prisons, $6,," Bertram outlined. "and if you can't pay that, either you can't see the doctor or that becomes a debt that you have to the prison."
The research found medical copays in prisons significantly impede health care access for more than 500,000 people with chronic conditions, from heart or kidney disease, to asthma and hepatitis C.
People in Mississippi prisons are not compensated for the jobs they may have while they are incarcerated, so Bertram pointed out it is up to their families to cover any medical costs. She added some states have dropped their copays for people behind bars. Her group thinks Mississippi should do the same.
"We have been advocating for years for states to abolish these copays," Bertram explained. "And some states are doing this, Nevada, I believe, abolished prison copays, either this year or last year. California has also abolished copays. To force people to pay to see a doctor, you know, causes people to not see doctors when they actually need help."
Bertram added the research revealed alarming gaps in mental health care access for incarcerated individuals. More than one-third of those with diagnosed chronic mental illnesses have not seen any mental health clinicians since entering prison.
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A 63-acre purchase by a local land restoration group in eastern Kentucky could potentially delay the building of a proposed $500 million federal prison.
The plot is located in a critical portion of a 500-acre prison site, which would be big enough to incarcerate more than a thousand people.
Mitch Whitaker owns neighboring land in Letcher County passed down through generations. He said the prison would essentially be in his backyard and supports the land buy.
"They were actually wanting to come right almost in my back door, off the hill, and the property was bounded pretty good by roads and rivers," Whitaker explained.
Supporters of the prison argued the project will create local jobs. But data from the Kentucky Center for Economic Policy show counties, including Martin, Clay and McCreary counties, which have been home to prisons for decades, continue to see among the lowest median household incomes in the nation.
Joan Steffen, attorney for the Institute to End Mass Incarceration, represented the Appalachian Rekindling Project, the group purchasing the land, and said they did not buy it just to sit on it.
"They were buying it to do this really amazing land remediation work, reintroducing native species, and their goal is to employ local people," Steffen outlined.
Whitaker believes his community deserves much more than another federal prison, noting there are already five in the region.
"Here in East Kentucky, these are as pretty mountains as you can have," Whitaker observed. "They're like the Smokies. You know, they're beautiful. I was against it from the start."
According to the Kentucky Center for Economic Policy, the Commonwealth incarcerates 40% more people per capita than the national average. Critics said the hundreds of millions of dollars planned for the prison could instead be spent on flood resilience, housing, reforesting degraded land, and funding child care and other community needs.
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A bill introduced by Kentucky lawmakers would increase alternatives to prison or jail for parents convicted of nonviolent offenses.
Most of the women and men in Kentucky's prisons and jails are also parents of young children.
Amanda Hall, senior director of national campaigns for the advocacy group Dream.org, who was separated from her child while incarcerated, said her son, who is now in college, testified before the Kentucky legislature about how being ripped from his mother left a lifelong imprint.
"When my son spoke, he said that he will never forget the day that I was arrested, and how that has literally changed his whole life," Hall recounted.
Around 12% of kids in the Commonwealth have an incarcerated parent, one of the highest rates in the nation. Considered an Adverse Childhood Experience, research has linked parental incarceration to higher rates of depression, substance abuse, decreased educational outcomes and homelessness among kids.
Hall explained alternatives to incarceration are aimed at addressing the root causes and conditions of why a crime was committed and work with families to prevent unlawful actions from happening again.
"It can be things like parenting classes and/or mental health or substance use disorder programming," Hall outlined. "It can be even having a case manager to try to help get people vocational training."
Cortney Downs, chief innovation officer for the nonprofit Kentucky Youth Advocates, said she believes the bill strikes a balance between personal accountability and keeping families together. She noted the effects of incarceration can be far-reaching and, in many cases, end up punishing children, who may struggle to have their basic needs met when a parent is imprisoned.
"Being incarcerated for even a short period of time can lead to job loss," Downs pointed out. "It can create barriers to securing a job in the future and it can also exacerbate financial hardships for families, especially if parents are having to pay court fines and fees or restitution."
Children of incarcerated parents often face an immediate threat of poverty. According to one advocacy group, nearly 50% of such children face frequent socioeconomic hardship.
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More than 60 counties in Pennsylvania have a shortage of public defenders for low-income residents who need these services.
This Friday in Pittsburgh, a recruitment event takes place to help fill jobs for public defenders' offices statewide. The University of Pittsburgh School of Law cohosts the statewide Career Day event with the Public Defender Association of Pennsylvania, to help connect law students from any law school with potential jobs.
Megan Lovett, director of public interest and pro bono initiatives at the university, said so far, they have 50 or more applications, for internships and attorney positions.
"We've had students that interviewed at this fair last year that ended up getting jobs in a county that maybe they wouldn't have considered before, and a county that may have had trouble recruiting from the law student population," Lovett reported.
She hopes like last year, counties across the state will see applicants from this event. Each year, public defenders' offices handle cases which would normally require more than 1,200 full-time attorneys but only about 850 are working statewide.
Andrew Capone, assistant director of training for the Public Defender Association of Pennsylvania, said he will be at the career fair, connecting law schools and individuals with these job opportunities. He argued a lack of state funding limits public defenders' offices, which drives the current shortage. But legislation passed last year should ensure indigent defense services for those who can't afford representation.
"Pennsylvania was, up until last year, one of the only two states in the country that did not fund a public defender office; they left it to the counties," Capone pointed out. "Since that time, Governor Shapiro has given what he and I refer to as a 'down payment' on statewide indigent defense."
Capone said Gov. Josh Shapiro allocated $7.5 million in the state budget, but divided among 67 counties, the effect is minimal, funding perhaps one additional attorney or staff member per office.
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