Prisoners are one of the most vulnerable populations in a society. Part of this vulnerability stems from the complete lack of their participation in the formation of the public policies that control their lives. As a result, the policies that target inmates are often influenced by negative societal perceptions, and therefore extremely punitive. However, as inmates have been found to possess a constitutional right to healthcare services, punitive policies that prevent barriers to their medical access must be carefully assessed. One of these policies that may potentially prevent inmate access to care is a copay policy requiring inmates to pay a fee in order to request medical care. While the adoption of these policies is often presented as a financial necessity by states, no evidence is found to support this claim. Instead, the results indicate that the primary factors influencing a state’s decision to adopt an inmate copay policy are the ideological make-up of a state’s government, and the racial make-up of a state’s inmate population. Specifically, states with conservative governments are more likely to adopt a copay policy, and states with a high proportion of Black inmates are more likely to adopt a copay policy. Furthermore, the results also indicate that when these policies impose debt on indigent inmates, they are resulting in increased inmate mortality rates and decreases in state corrections expenditures. Therefore, while the states are correct in their assertions that these policies save money, these savings come at the cost of inmate lives. This result is alarming, especially in light of the finding that the adoption of these policies is the result of ideological and racial factors.