Medical Debt Behind Bars: New Report Examines the Impact of Medical Debt on Incarcerated People

September 10, 2024 — Press Release

Advocates Recommend Eliminating Fees for Medical Care in Prisons and Jails and Ending the Collection of Carceral Medical Debt

WASHINGTON – The population of individuals incarcerated in jails and prisons across the United States is getting sicker and older and, unsurprisingly, the cost of caring for them is increasing. While medical debt is a burden that many Americans are familiar with, a new report from the National Consumer Law Center examines the lesser known and acute impact of this continuing crisis on incarcerated people.

Medical Debt Behind Bars: The Punishing Impact of Copays, Fees, and Other Carceral Medical Debt gives an overview of the problem of carceral medical debt, including the complex healthcare needs of people who are incarcerated, what fees are assessed and why, and how these fees impact health outcomes and lead to medical debt. 

“Incarcerated people are disproportionately low-income and they often earn pennies an hour for their work while incarcerated, if they are even paid at all,” said Anna Anderson, staff attorney at the National Consumer Law Center and author of the report. “The cost of medical care often falls on already-burdened and financially strapped families. For those without outside financial support, the prohibitive cost of medical care can turn a prison sentence into a death sentence.”

In 2021, the Department of Justice found that 40% of incarcerated people in state prisons and 33% of incarcerated people in federal prisons reported having a chronic health condition. The increasing role of for-profit corporations and private-equity-backed firms in providing healthcare in prisons and jails raises concerns among advocates that bottom lines will take precedence over health outcomes. 

“While jails and prisons cannot legally deny care due to a person’s inability to pay, charging fees for care leads to worsening health outcomes for individuals and prison populations as a whole,” said Anderson. “These fees make it nearly impossible for the majority of incarcerated people to afford medical assistance without accumulating debt.”

Carceral debt exacerbates existing racial health and wealth disparities. Incarceration rates for Black and Hispanic/Latino people are significantly higher than for white people, and medical debt already disproportionately impacts Black communities. The report recommends reforms policymakers must implement to lessen the impact of carceral medical debt, including: 

• Eliminating medical fees and providing free medical care to people in prisons and jails;
• Stopping collection of carceral medical debt;
• Preventing private contractors from profiting off incarcerated individuals, jeopardizing their health and financial well-being; and
• Increasing access to Medicaid and Medicare in prisons and jails.

“Reducing prison populations, and particularly aging populations, is critical to decreasing costs and strains on the system and delivering better healthcare to people who are incarcerated,” said Anderson. “We cannot resolve the issue of carceral medical debt without also taking meaningful steps to end mass incarceration.” 

Related Resources

• NCLC Comments on Proposal to Expand Medicare Eligibility to People on Parole, Probation, or Home Detention, September 9, 2024
• Captive Concerns: Incarcerated People Face Obstacles to Reporting Consumer Abuses, July 22, 2024
• Inquest: Captive Consumers: How government agencies and private companies trap and profit off incarcerated people and their loved ones by NCLC staff attorney Ariel Nelson and Stephen Raher of the Prison Policy Initiative, March 19, 2022
• The Racial Health and Wealth Gap: Impact of Medical Debt on Black Families, March 9, 2022
• Sentenced to a Life of Debt: It Is Time for a Reassessment of How Bankruptcy Law Intersects with Fines and Fees to Keep People in Debt, February 16, 2022