In a system where incarcerated individuals often earn mere pennies per hour, a $5 medical copay can represent a week’s wages. This stark reality is at the heart of a growing healthcare crisis in American prisons, where financial barriers are forcing inmates to choose between basic necessities and medical care. A new report by the Prison Policy Initiative (PPI) reveals that these copays are dramatically reducing access to healthcare for the nation’s 1.2 million state and federal prisoners, with devastating consequences for the most vulnerable among them.