This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

The Citizens Research Council of Michigan (CRC) recently reported that Michigan prisons spend approximately $300 million per year to provide health care for more than 30,000 prisoners. Even after adjusting for inflation, the average per-prisoner health care cost has increased 34% over the last two decades. And, according to Michigan advocates for incarcerated and formerly incarcerated people, health care in prison is far less than adequate. 

Adam Grant, executive director of the nonprofit A Brighter Way, rates Michigan's prison health care a three on a scale of one to 10. 

"I think it's wholly inadequate," Grant says. "They do enough just to keep you alive. Any type of required surgeries, you have to jump through hurdles and get approved by four different sets of administration. When you're really ill, the answer is generic-brand Tylenol and water. It's never anything that's actually designed to help you stay healthy."
Adam Grant.
Ken Nixon, director of outreach and community partnerships for Safe & Just Michigan, has an even dimmer view of Michigan prison health care, rating it a two on a scale of one to 100.

"When you actually get health care, it's okay," Nixon says. "But the process is arduous and is meant to deter people from engaging not only in preventative care but in responsive care. The bedside manner is terrible. It trains you not to be a participant in your health."
Ken Nixon.
Grant spent 27 years as an inmate in Michigan correctional facilities. Nixon was incarcerated more than 10 years before he was exonerated and released. Both now dedicate themselves to prison reform and successful re-entry for others who have completed their sentences. They agree that failure to provide adequate health care within correctional facilities results in higher costs for communities when incarcerated individuals return with a host of physical and mental health problems that have gone largely untreated.

"They're spending our tax dollars, but they're not doing a very good job investing it," Grant says. "They're not investing it in people, and they're not investing it in the ideals that make us better as a society."

When Grant was tested for Hepatitis C during his incarceration, he was not informed of the positive result for roughly eight years. It was another six years before he received treatment, by which time he had developed stage four cirrhosis of the liver.

"Prison is not a place for people who have chronic illness or for our elderly. The system is not designed to sustain your health for long periods of time," Nixon says. "A lot of ailments get neglected. There's a copay associated with requesting health care, and many can't afford to pay the copay. If we had some data behind it, it would certainly require changes be made, considering the population is continuously getting older. Older people need more medical attention. You also have youth coming into the system off the streets with hereditary diseases or stuff that they were diagnosed with prior to incarceration that aren't being treated properly."

Report calls for data to initiate reforms

In its September 2023 report, the CRC stated it could not achieve its original research mission of assessing health care in Michigan's prisons because little data is available to draw from. In a media release, the CRC said, "… while the Michigan Department of Corrections (MDOC) tracks raw data, it is only required to provide high-level data to the public and is not required to provide sufficiently detailed reports to the legislature." An MDOC spokesperson declined interview for this story.
Karley Abramson.
"We need data on health care spending and health outcomes to know if we are providing adequate care for prisoners," says report author Karley Abramson, CRC health affairs/health policy associate. "Are they being taken care of up to the constitutional standards that we are supposed to meet? Is the care we are providing efficient? And is it the best use of taxpayer money? Using our resources as effectively as possible may open up some resources for improved quality of care."

There are many possible reasons for why costs for health care in prisons have escalated, including privatized care, an aging prison population, substance use disorders, mental illness, and poor health before incarceration. But the lack of data prevents true solutions from being developed.

"We really need the data to know where the problem is coming from," Abramson says. "Michigan has a hybrid model, where we outsource some [health care services] to contractors, and some of the services are provided directly by the department. Each method has different pros and cons. The best way to know which model would be the most cost-effective and will lead to better health outcomes is to compare that data."

"I think the state needs to be better at this, whether it's done in-house or through a third party," adds Eric Lupher, CRC president. "Corrections is one of the biggest line items in the budget. Health care is one of the biggest line items in the corrections budget. Oversight, done properly, would involve the legislature asking these questions and collecting this data and being able to scrutinize what's going on. We don't want to hand money to a third party and assume that we're getting everything that we hoped for with our taxpayer dollars."
Eric Lupher.
The CRC report concluded that providing health care to inmates has high costs, which the state does not adequately assess; data is needed to identify cost drivers in order to improve quality of care and maximize cost-effectiveness; and, since every Michigan resident has a stake in the quality and efficiency of the prison health care system, the state should make relevant data available to policymakers and the public. 

State and federal constitutional legal protections are guaranteed to prisoners. Without data, it's also hard to determine if those legal protections are being upheld.

"First, we will be protecting the state from losing money. Potential lawsuits could arise from our failure to provide that constitutionally required adequate care to prisoners," Abramson says. "Overall, taxpayer dollars fund prison health care. It's really in everybody's best financial interests that we're using those resources as efficiently and as wisely as we possibly can. Most prisoners are released. They come back into their communities. It is in everyone's best interest that they are as healthy and productive as possible."

Legislation is the answer

CRC staff hope that their report will lead to conversations with the state's appropriations committees for corrections, as well as legislating requirements for better data collection and sharing.

"I definitely think having more data, having more accurate data, having more real-time data would definitely change the way the system operates. However, it depends on how that data is collected," Nixon says. "If we leave it to the people that are providing the inadequate health care to also provide us with data — I don't think we're going to get the results that we're looking for, either."

Grant wants to see health care reform within the state's correctional facilities. He also fears that data provided by the profit-driven corporations — Grand Prairie Healthcare Services, P.C. and Wellpath LLC — handling a large portion of the MDOC's health care responsibilities would not be reliable.
Adam Grant.
"If I had my druthers, I think a more effective system would be if the state took all of the prison health care back over and used it as an educational opportunity for people doing their [medical] residencies," he says. "I think it would be more cost-effective, more humane, and a good experience for the students."

Better data collection and analysis could not only improve cost-effectiveness of the health care prisoners receive but also release mentally and physically healthier individuals back into Michigan's communities.

"It's a question of why are we locking people up," Lupher says. "Are we locking them up because we're mad at them and we want to punish them? Or, as the name corrections suggests, [because] we want to help them, reform them, so they can live better lives? If we want them to live better lives, then we shouldn't punish them with the life sentence of having some malady incurred in prison. We should want them to come out, be better, be part of the workforce, part of their families, and part of the community."

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Adam Grant and Eric Lupher photos by Doug Coombe. Ken Nixon photos by Roxanne Frith.