Health Care in U.S. Correctional Facilities — A Limited and Threatened Constitutional Right

This Perspective explores the precarious legal and operational status of health care in U.S. correctional facilities. Although the Supreme Court’s 1976 Estelle v. Gamble decision affirmed incarcerated people’s constitutional right to medical care, real-world enforcement is undermined by ambiguous standards, systemic underfunding, and the restrictive Prison Litigation Reform Act (PLRA). The article highlights structural barriers to legal recourse, such as the “deliberate indifference” threshold and procedural hurdles faced by inmates, and outlines landmark cases including Helling v. McKinney and ADA-related litigation. The authors propose a two-pronged solution: amending or repealing PLRA to enable reactive legal accountability, and establishing proactive, federally mandated health care standards with independent oversight. International models like the Mandela Rules and OPCAT are cited as potential blueprints, alongside Medicaid expansion efforts such as California’s Section 1115 waiver.

This Perspective explores the precarious legal and operational status of health care in U.S. correctional facilities. Although the Supreme Court’s 1976 Estelle v. Gamble decision affirmed incarcerated people’s constitutional right to medical care, real-world enforcement is undermined by ambiguous standards, systemic underfunding, and the restrictive Prison Litigation Reform Act (PLRA). The article highlights structural barriers to legal recourse, such as the “deliberate indifference” threshold and procedural hurdles faced by inmates, and outlines landmark cases including Helling v. McKinney and ADA-related litigation. The authors propose a two-pronged solution: amending or repealing PLRA to enable reactive legal accountability, and establishing proactive, federally mandated health care standards with independent oversight. International models like the Mandela Rules and OPCAT are cited as potential blueprints, alongside Medicaid expansion efforts such as California’s Section 1115 waiver.