The urgent case for prison healthcare reform

Medicaid, one of the more robust social programs in the US, provides healthcare to over 90 million people. Its goal is to bridge gaps in healthcare access for low-income individuals and promote equity in care for pregnant women and those with disabilities. Yet, a key group encompassing around 2 million Americans is left out every year– incarcerated individuals. Over two million are incarcerated, still there is a lack of appropriate healthcare. 

The landmark 1976 Supreme Court case Estelle v. Gamble established healthcare as a constitutional right for prisoners and that the deliberate refusal of care violates that right; however, the healthcare rights of the incarcerated are violated daily. For instance, more than one in five inmates were taking prescription medication when they entered prison or jail, but 26% of federal inmates and 29% of state inmates stopped the medication following incarceration. A similar pattern is seen for patients who required regular lab testing but stopped once incarcerated. Abrupt disruptions in medication usage and the inability to properly treat chronic conditions can only worsen health and lead to adverse outcomes that can harm an individual's eventual reentry into society.

Most alarming, however, is the rate at which diseases disproportionately impact inmates. Studies have shown that inmates have higher blood pressure rates, asthma, cancer, and infectious diseases like hepatitis C and HIV. The rates for asthma and hepatitis C were the most troubling. For example, 16.7% of inmates have asthma compared to 8.0% of non-incarcerated individuals. Similarly, 9.5% of incarcerated individuals have hepatitis C, while less than 2% of the general population does. The evident disparity in disease prevalence is a reflective violation of prisoners' healthcare rights, since it suggests unsanitary conditions, a lack of medications, etc.

While people are only getting sicker, some individuals in prisons that use private insurance contractors refuse care altogether due to its steep copay. Although a $2-5 copay feels like pennies on the dollar, incarcerated universals are paid only around 14 to 63 cents per hour. To make matters worse, prices for food in the commissary increased between 230.5% to 2722.0% higher than the rate of the same item in a grocery store. Being forced into spending limited funds on either healthcare or access to snacks that are more nutritious than the daily prison meals when both are necessary is an incredibly abusive system.

Another barrier to healthcare access is the mistrust inmates have in the broken healthcare systems–and rightfully so. Investigations conducted into New York City prisons like Rikers Island jail reveal violations of constitutional rights. For example, 71% of women mistrust the prison healthcare system due to inappropriate treatment. Inmates, in general, also mistrust the medical centers since their needs are generally ignored and care is typically very minimal. The current state of prison healthcare violates constitutional rights and deprives a vulnerable group of the right to health. 

The health of incarcerated individuals can be remedied by expanding Medicaid to include those incarcerated. Allowing prisoners access to a federally regulated program can provide more oversight and can help reduce high copays and restrictive access to care. 

Similarly, it is crucial to allow each state's health department to create a position that oversees prison healthcare. Giving the power to the state Department of Health instead of the Department of Correctional and Community Supervision, which does not have as much bandwidth, can prevent abuse from correctional officers or inappropriate care denials from contracting insurance companies. 

In New York, legislators have tried proposing this idea. However, former Governor Andrew Cuomo vetoed it even after the narrowed legislation so that the new state Department of Health position would only monitor the spread and rates of infectious diseases instead of overseeing chronic condition care programs and screenings. Recently, the state assembly proposed the legislation but failed in the state Senate. Narrow legislation is useless, as it leaves a vulnerable community partially protected and is akin to placing a bandage on a deep gash. 

New York State spends around $400 million on prison healthcare–a good chunk coming from taxpayer dollars. Instead of uselessly throwing money at something broken, restructuring state oversight of prisons can also maximize each dollar spent. 

These innovative initiatives can help reduce recidivism in the long term as well. Consistent access to physical and mental health care can allow incarcerated individuals to strengthen their mental health and persevere despite challenges during re-entry, such as the difficulty of finding jobs or a support system. Continuity of care can also allow the incarcerated who have served their terms to find employment without the barrier or fear of missed days due to hospital visits or complications due to chronic health conditions.