TL;DR
People in prison have a legal right to health care. But the state fails to protect that right. Nearly 800,000 people in prison have a long-term health problem. More than 1 in 5 get no care at all. Private companies run most prison health care. They make money by spending less on care. People die because of this. Death rates are 18% to 58% higher at prisons run by these companies. When families sue, the companies file for bankruptcy to dodge paying.
Why This Matters
If your loved one is in prison, this affects them directly. When they put in a sick call, a private company decides if they get care. That company makes more money by saying no.
Every year someone spends in prison cuts two years off their life. That means your loved one may come home sicker. They may come home with problems that went untreated for years.
More than 95% of people in prison will come home. When the state denies them care, it hurts whole families and communities. This is not just a prison problem. It is a public health crisis.
Key Takeaway: Prison health care failures don’t stay behind bars — they follow people home and affect entire families and communities.
The Law Says People in Prison Deserve Care — But the System Fails Them
In 1976, the Supreme Court ruled that ignoring the health needs of people in prison is cruel and unusual punishment. The case was called Estelle v. Gamble. The Court said the state must provide health care.
But the legal bar is very high. To win a case, a person must prove that a prison worker knew about a serious health need and chose to ignore it. Simple mistakes or poor care are not enough under the law.
On top of that, a 1996 law called the Prison Litigation Reform Act makes it much harder to sue. People in prison must first go through all internal complaint steps. This can take months or years.
Despite these hurdles, at least 52 lawsuits have forced 26 states to fix their prison health care since 2000. That is about half of all state prison systems. Alabama alone has been ordered by courts six times to improve care.
Key Takeaway: Half of all state prison systems have been taken to court and ordered to fix their health care since 2000.
The Numbers Show a Health Crisis
Here is what the data tells us:
- Nearly 800,000 people in prison have a long-term health problem.
- Over 20 percent of people with ongoing health needs in state prisons get no care.
- In local jails, that number jumps to more than 68 percent. That means more than 2 out of 3 people who need care don’t get it.
- Over 27% of people in prison who have a long-term health problem were first told about it while locked up. They never got help before prison.
- People in prison are 6 times more likely to get sick from bad food than people on the outside.
Each year in prison takes two years off a person’s life. If not for mass locking people up, U.S. life expectancy (how long people live on average) would be five years longer.
Key Takeaway: More than 2 out of 3 people in local jails who need ongoing health care are denied it.
Private Companies Run Prison Health Care — and People Die
A few big companies control most prison health care. The biggest is Wellpath. It runs health care in over 550 prisons across 37 states. It makes $2.7 billion a year. It serves more than 300,000 people.
The second biggest is YesCare (formerly Corizon). It ran health care in 149 prisons in 16 states. It made about $800 million a year.
In total, the private prison health care market brings in about $6 billion a year.
A 2020 Reuters review looked at over 500 jails. It found that prisons using the top five private companies had death rates 18% to 58% higher than prisons where the government ran health care itself.
That means people are more likely to die when a private company is in charge of their care.
Key Takeaway: People in prisons run by private health care companies die at rates 18% to 58% higher than in government-run prisons.
How These Companies Make Money by Cutting Care
There are three main ways these companies get paid. All three reward spending less on care:
- Flat rate: The state pays a set amount per person. The company keeps whatever it doesn’t spend on care. Every dollar saved is profit.
- Cost-plus: The state pays all costs plus a fee. But the company still cuts costs to win the next contract.
- Spending cap: The company pays the first big chunk of costly care. This pushes companies to avoid giving costly treatments.
All three models put profits first and patient care last.
Here are some common ways they cut costs:
- Saying no to treatments and drugs — even ones people took before prison
- Telling sick people to “take Tylenol” or “drink water” no matter how sick they are
- Hiring fewer workers or workers with less training
- Having one doctor cover many prisons over a huge area
- Assuming people are faking their symptoms
- Making guards decide who gets to see a doctor
- Having guards sit in during doctor visits, which stops people from speaking freely
Key Takeaway: Every major payment model in private prison health care rewards companies for spending less on patient care.
When Families Sue, Companies File Bankruptcy to Avoid Paying
In 2023 and 2024, three of the biggest prison health care companies filed for bankruptcy (a legal process to get out of debt):
Corizon Health had over $1 billion in lawsuit payouts on its books. It used a legal trick called the “Texas Two-Step.” It split into two parts. One part held all the debts. The other held the valuable assets. This shielded the money from the families who were owed it.
Wellpath had about 1,500 open lawsuits for bad care in just seven years. It filed for bankruptcy in November 2024 to cut about $550 million in debt. It settled with those it owed money to for just $15.5 million.
A CNN review found that Wellpath’s earlier company was blamed in lawsuits for helping cause more than 70 jail deaths between 2014 and 2018.
Armor also filed for bankruptcy.
Senator Elizabeth Warren spoke out. She said Wellpath was using bankruptcy to dodge being held to account.
Key Takeaway: Three major prison health care companies filed bankruptcy to avoid paying families of people who died or suffered from neglect.
States Spend Wildly Different Amounts on Care
In 2015, the typical state prison system spent $5,720 per person on health care. That covers medical, dental, mental health, and drug treatment.
But the gap between states is huge:
- California, New Mexico, Vermont, and Wyoming spent over $10,000 per person.
- Alabama, Indiana, Louisiana, Nevada, and South Carolina spent less than $3,500 per person.
That means some states spend nearly three times as much as others. In total, 49 state prison systems spent about $8.1 billion on health care in 2015.
A federal rule called the “Inmate Exclusion Policy” blocks prisons from using Medicaid money. This forces states to pay the full cost. It pushes them to cut corners.
Key Takeaway: Some states spend nearly three times more per person on prison health care than others, and federal rules block Medicaid from filling the gap.
Almost No Oversight Exists
Three groups offer checks on prison health care quality. But joining is a choice — not a rule. Most prisons choose not to. Out of 4,575 prisons in the U.S., only a small number have been reviewed.
Courts have said prisons do not have to be reviewed. There are no federal rules for pregnant people in prison, even though about 58,000 pregnant people enter jails and prisons each year.
Contracts between states and private companies often protect the state from lawsuits. The company must pay legal costs. This means the state has less reason to watch over the company closely.
Key Takeaway: Most prisons choose not to be reviewed, and there are no federal rules for care of pregnant people behind bars.
What This Looks Like in Georgia
The U.S. Department of Justice found Georgia prison conditions “out of control” and “unconstitutional.” Georgia is among the states that spend less per person on health care.
Corizon, the company with over $1 billion in lawsuit debts, used to work in Georgia prisons.
At just one jail — the Chatham County jail in Savannah — a private company spent $1.3 million in a single year (2011) on ambulance rides and hospital stays alone. This shows what happens when care is delayed. Small problems become emergencies. Emergencies cost more and risk lives.
Key Takeaway: Georgia’s prison conditions were called ‘unconstitutional,’ and delayed care at one jail cost $1.3 million in emergency costs in a single year.
What Experts Say Should Change
The Prison Policy Initiative says we need to:
- Take health care out of prison control. Let health experts run it.
- Move toward public care. Stop letting private companies profit from sick people.
- Reduce the number of people in prison. Fewer people locked up means better care for those who are.
- Set clear quality standards. Track care the same way across all states.
- End the Medicaid ban. Let federal money help pay for prison health care.
- Fix the lawsuit rules. Make it easier to hold prisons and companies to account.
- Be open about what happens. Publish data so families and the public can see.
Key Takeaway: Experts say prison health care should be run by health professionals — not prison systems or private companies seeking profit.
Glossary
- Deliberate indifference: When a prison worker knows someone has a serious health need and chooses to ignore it. This is the legal standard for proving rights were violated.
- Serious medical need: A health problem that a doctor says must be treated, or one so clear that anyone could see it needs a doctor.
- Prison Litigation Reform Act (PLRA): A 1996 law that makes it much harder for people in prison to sue over bad conditions.
- Inmate Exclusion Policy: A federal rule that bars prisons from using Medicaid (government health insurance) money to pay for care.
- Capitation (flat rate): When the state pays a set amount per person. The company keeps what it doesn’t spend. Less care means more profit.
- Malingering: The claim that a person is faking illness. Prison staff often use this to deny care.
- Section 1983: A federal law that lets people sue state workers — including prison staff — for violating their rights.
- Accreditation: A voluntary review process. Most prisons skip it. Courts don’t require it.
- Texas Two-Step: A legal trick where a company splits in two to hide its money from people it owes.
- Indemnification: Contract terms that protect the state from paying when things go wrong. The health care company pays instead.
Read the Source Document
Read the full GPS analysis: Prison Healthcare & Medical Neglect (PDF)