The COVID-19 pandemic profoundly harmed the health and safety of incarcerated people in the United States and has underscored the lack of resources and oversight that hinder medical care in correctional facilities. The United States Constitution guarantees freedom from “deliberate indifference” to “serious medical needs,” a legal standard that does not assure the consistent provision of health care services. As such, the U.S. falls behind European nations that define universal standards of care grounded in principles of human rights, and, in particular, on the ideal of equivalence that incarcerated and non-incarcerated people are entitled to the same health care. Drawing on diverse legal, public health, and ethics literatures, this paper develops a conceptual analysis of the standard of care in correctional health and describes a framework for moving incrementally closer toward a universal standard. The paper argues that the expansion of Medicaid funding and benefits for incarcerated people (which has long been prohibited under federal law) alongside a system of comprehensive and enforceable external oversight would meaningfully raise the standard of care, and thereby move closer to the equivalence ideal. We consider the opportunities to improve current oversight models, which often lack public transparency, enforceability, and fact-finding capacity. These changes, on their own, will not resolve all of the thorny health problems posed by mass incarceration, but they present a tangible opportunity to make progress.
Co-Authors: Gabriel Eber; Carolyn Sufrin; Chris Beyrer; Leonard Rubenstein