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

This article examines the precarious constitutional right to health care for incarcerated individuals in the U.S., established under the Eighth Amendment via Estelle v. Gamble (1976), which prohibits "deliberate indifference" to serious medical needs. Despite this, systemic barriers including judicial ambiguity, the restrictive Prison Litigation Reform Act (PLRA), and lack of Medicaid funding severely limit access to adequate care. The PLRA imposes hurdles like proof of physical injury, exhaustion of administrative remedies, and financial burdens, deterring litigation. Even successful cases yield narrow, temporary remedies (e.g., hepatitis C treatment in Massachusetts). The article warns of potential erosion of this right under originalist judicial interpretations, citing Dobbs v. Jackson as a precedent. Proposed solutions include repealing the PLRA, adopting international standards (e.g., Mandela Rules), and creating enforceable federal oversight, modeled after the Prison Rape Elimination Act (PREA). The piece underscores the urgency of legislative action to address health inequities for a disproportionately marginalized population.

This article examines the precarious constitutional right to health care for incarcerated individuals in the U.S., established under the Eighth Amendment via Estelle v. Gamble (1976), which prohibits "deliberate indifference" to serious medical needs. Despite this, systemic barriers including judicial ambiguity, the restrictive Prison Litigation Reform Act (PLRA), and lack of Medicaid funding severely limit access to adequate care. The PLRA imposes hurdles like proof of physical injury, exhaustion of administrative remedies, and financial burdens, deterring litigation. Even successful cases yield narrow, temporary remedies (e.g., hepatitis C treatment in Massachusetts). The article warns of potential erosion of this right under originalist judicial interpretations, citing Dobbs v. Jackson as a precedent. Proposed solutions include repealing the PLRA, adopting international standards (e.g., Mandela Rules), and creating enforceable federal oversight, modeled after the Prison Rape Elimination Act (PREA). The piece underscores the urgency of legislative action to address health inequities for a disproportionately marginalized population.