Because sometimes it takes pain to make us pay attention…
This weekend, I broke two ribs.
It wasn’t dramatic. No heroic story. Just one of those moments where life reminds you, (quickly and clearly) that your body is not invincible. And if you’ve ever broken a rib, you know there’s no ignoring it. Every breath, every laugh, every attempt to roll over in bed reminds you.
But here’s what struck me most: I didn’t hesitate to get care.
I didn’t weigh whether I could afford to be seen.
I didn’t debate whether the pain was “bad enough” to justify the cost.
I didn’t calculate whether I could tough it out for a few days.
I just went.
And that, right there, is a privilege far too many people in this country, and especially people who are incarcerated, do not have.
Health Care Behind the Fence: Access in Name Only
We often say that incarcerated individuals are guaranteed health care. That comes from the Supreme Court case Estelle v. Gamble, which established that deliberate indifference to serious medical needs violates the Eighth Amendment.
On paper, that sounds like protection.
In practice, it’s a very different story.
Access to health care in correctional settings is often delayed, limited, or conditioned on barriers that would never be acceptable in the community. One of the most significant, and frankly, least talked about, barriers is cost.
Yes, cost.
Despite earning pennies per hour (if they are paid at all), incarcerated people in most states are still charged co-pays to access medical care.
According to recent data, 40 states still charge incarcerated individuals co-pays for medical visits.
Let that sink in.
When “Just Go to the Doctor” Isn’t an Option
Imagine you’re earning $0.14 to $1.00 per hour (if you have a job at all).
Now imagine you’re told it will cost you $3 to $5 just to be seen by medical staff.
That might not sound like much on the outside. But inside, that can represent weeks of wages.
So what happens?
People wait.
They delay reporting symptoms.
They try to self-manage pain.
They ignore issues until they become emergencies.
And by the time they’re seen, what could have been a simple, low-cost intervention has turned into something far more serious and far more expensive.
We’ve essentially created a system that penalizes early care and rewards crisis.
A Story I Can’t Shake
I have a colleague, a brilliant, dedicated professional, who spent time incarcerated earlier in his life. He’s now doing incredible work in the community, mentoring others and helping people rebuild their lives.
But his health tells a different story.
During his incarceration, he was repeatedly denied dental care. Not delayed…denied. What started as manageable dental issues turned into chronic infections, tooth loss, and long-term complications that didn’t stop at his mouth.
Today, he deals with a cascade of health problems, some directly tied to those untreated issues, others connected in ways we now understand more clearly through research on inflammation and systemic health.
Dental care is health care, but in many correctional systems, it’s treated as optional, or worse, as a privilege.
And he’s not an outlier. He’s one of many.
The System We’ve Built
Let’s be honest about what this is. We’ve created a system where:
Preventive care is discouraged
Minor issues are allowed to escalate
Chronic conditions go unmanaged
People leave incarceration sicker than when they entered
And then we send them back to the community, back to families, workplaces, and already strained health systems, and expect a different outcome. If we’re serious about reentry, workforce development, and reducing recidivism, we cannot ignore health. Health is not separate from success. It’s foundational to it.
This Isn’t Just a Moral Issue—It’s a Practical One
There’s a tendency to frame this conversation as purely humanitarian, and it is. But it’s also deeply practical. Untreated health issues lead to:
Higher emergency care costs
Increased burden on public health systems
Reduced ability to work and maintain employment
Greater stress on families and communities
In other words, we pay for it anyway. We just choose to pay for it later, when it’s more expensive, more complicated, and more damaging.
So What Do We Do?
If we’re going to take responsibility (and I believe we must) then we have to start rethinking the system itself.
Not tweaking around the edges. Rethinking.
What would it look like to:
Eliminate or significantly reduce medical co-pays for incarcerated individuals?
Prioritize preventive and routine care, including dental and mental health services?
Integrate correctional health care more intentionally with community health systems for continuity of care upon release?
Hold systems accountable not just for access, but for outcomes?
Because “available” care that people cannot realistically access is not access.
A Final Thought (from Someone Who Can Breathe… Carefully)
As I sit here, gingerly sipping my coffee and trying not to laugh (because wow, ribs are unforgiving), I keep coming back to this: I had a choice.
I had access.
I had resources.
I had the ability to act on my pain.
Millions of people do not, and for those who are incarcerated, that lack of access isn’t accidental. It’s built into the system. If we believe in second chances, and I know many of us reading this do, then we have to believe in something even more basic:
That people deserve the ability to take care of their health.
Not eventually.
Not conditionally.
Not when it becomes an emergency, but when it first starts to hurt.
☕ I (gingerly and with my left hand) tip my coffee cup to you today, wishing you good health and the capacity to keep your good health. Tallyho life warriors!
