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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If you have any unpaid traffic or parking tickets, the latest report on Wisconsin's municipal courts said in some areas, you could go to jail if you do not pay them, and the risk is higher for people of color.

The report from the ACLU of Wisconsin showed most municipal courts across the state do not issue jail sentences or fines, known as "carceral sanctions," but some still do.

Emma Shakeshaft, senior staff attorney and researcher for the ACLU of Wisconsin, said it seems the burden falls harder on under-resourced residents.

"The detrimental effect of these forfeitures in general, and especially warrants and commitments, fall disproportionately on communities without resources -- financial resources -- and people of color," Shakeshaft reported.

Of the more than 200 municipal courts in Wisconsin, the report showed about 52 still impose jail time and fines. While the report does not include a statistical analysis of racial disparities, Shakeshift pointed out court-provided data show about 70% of warrants and about 50% of commitments issued in Milwaukee between January 2023 and August 2024 were for defendants who are Black.

If you find yourself in a municipal court and cannot afford to pay your tickets, Shakeshaft noted you have the right to request what is known as a poverty hearing, to request payment alternatives. But the report found instead, most of the courts still using carceral sanctions implement aggressive tactics like jailing people for unpaid tickets to increase enforcement and funding.

Shakeshaft added some people have multiple unpaid tickets for city ordinance violations, from traffic or parking tickets to disorderly conduct and issues with vehicle registrations.

"Paying that off can be an incredibly difficult task," Shakeshaft emphasized. "For people who can't afford it, they're just continuously kept in the legal system."

Shakeshift stressed while the infractions are not criminal offenses, the outcome for some people is the same in courts issuing carceral sanctions. The ACLU of Wisconsin is asking all municipal courts across the state to end the practices and implement what it called a more rational and equitable approach to addressing debts.


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This week, President Joe Biden commuted the sentences of 37 people with federal death row convictions to life sentences without parole.

Groups working on criminal justice reform said it is a start but they would like to see him do more. According to the advocacy group FWD.US, one in two Americans has experienced incarceration in their immediate family and one in three has a criminal record.

Zoë Towns, executive director of FWD.US, applauded Biden's actions and urged him to focus on clemency for those still serving long sentences.

"What we are calling on is for the President in these final weeks of his administration, focus clemency on sentence commutations for people who are in prison," Towns explained. "However, of all of those people -- the pardons and the commutations on home confinement -- nobody actually walked home from prison, right? Nobody's prison term was reduced in any way."

Towns noted most recent commutations for people on house arrest basically removes the threat of reincarceration. She added they are cautiously optimistic Biden will focus on the issue, as a White House news release mentioned the possibility of more pardons and commutations.

Towns pointed out many long-term prison sentences disproportionately affect Black people, citing racial disparities in the harsher past sentences for cocaine possession. The 2010 Fair Sentencing Act reduced the gap but Towns added many remain imprisoned under outdated laws, underscoring the need for clemency.

"We believe that the federal prison population is far too large," Towns contended. "One in eight people who are in prison in the United States are incarcerated in the federal system. There are thousands of people -- nearly 200,000 people -- who have been in that system, who are serving extremely long sentences, and they need attention."

In a bipartisan poll conducted this fall by FWD.US, Towns said more than 80% of respondents agreed clemency should be used more frequently to address lengthy sentences.


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Oregon's constitution guarantees criminal defendants a state-funded lawyer for those who cannot afford one but a massive shortage of public defenders makes it unachievable.

According to the Oregon Justice Research Center, more than 90% of people charged with crimes in Oregon depend on a public defender. However, Oregon has less than a third of the public defense attorneys needed to handle all the cases.

Currently, more than 3,400 Oregonians charged with crimes have no lawyer.

Shannon Wilson, executive director of Public Defenders of Marion County, said public defenders are so overwhelmed with cases they can get burned out after a few years.

"There's not enough attorneys to address that work unless you want to adopt the belief that 300 clients per one attorney is enough to get legal representation," Wilson pointed out.

The Oregon Public Defense Commission estimates the state needs 500 more public defenders to meet its obligations. In 2023, lawmakers approved $96 million for attorney retention, recruitment and pay equity with prosecutors. But the commission said it is not enough.

The Oregon Criminal Justice Commission said recriminalizing low-level drug possession, enacted this year, will lead to nearly 2,300 additional convictions annually, disproportionately affecting people of color. Wilson noted if you can't afford a lawyer, you will likely get put on a waiting list and the wait can be 5 months or more.

Without a lawyer, some people end up spending needless time in jail and are less likely to have a fair trial. Most of Wilson's public defense clients face poverty, medical, or substance-abuse challenges and Wilson added stigma remains a significant barrier to fully funding Oregon's public defense system.

"This is our community, and I feel like we all have a responsibility to take care of everyone," Wilson stressed. "Especially the most vulnerable people that can't advocate for themselves. "

Despite the barriers, Wilson is optimistic Oregon legislators are heading in the right direction. The Oregon Public Defense Commission recommends doubling the state's two-year public defense budget from nearly $600 million to $1.3 billion by 2030.


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