Medicare in prisons an essential human right

Advocating for Medicare in prisons is an important and often overlooked issue in the broader healthcare debate.

Many incarcerated individuals have significant healthcare needs, yet they often don’t have adequate access to necessary medical services. Medicare could be a key part of addressing these challenges, but there are several points to consider.

Why Medicare in prisons?

Prevalence of chronic conditions: The incarcerated population tends to have higher rates of chronic health conditions, such as heart disease, diabetes and mental health disorders. Introducing access to Medicare in prisons and expanding healthcare in prisons can help provide the kind of comprehensive care that is currently lacking in many prisons.
Ageing inmate population: The Australian prison estate (132 prisons) is home to an increasing number of older adults who often require more medical care. Medicare could offer a solution for covering the healthcare costs of ageing prisoners who need long-term care, rehabilitation and management of age-related conditions.
Cost-effective for taxpayers: Many argue that providing healthcare through prison Medicare could reduce criminal justice system costs. With more comprehensive healthcare access, prisoners should receive preventative care, reducing the need for expensive emergency room visits and hospitalisations.
Humanitarian considerations: Healthcare is a fundamental human right and prisoners, despite their incarceration, should not be denied necessary medical treatment. Providing Medicare or other forms of healthcare would align with ethical principles of equity and justice.

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Challenges and considerations

Logistical barriers: One challenge to implementing Medicare in prisons is the administrative and logistical hurdles. Prison systems are often not set up to process Medicare claims and integration would require significant coordination between the prison healthcare system and federal programs like Medicare. These hurdles are certainly surmountable.
Legal and policy issues: Inmates are excluded from enrolling in Medicare if they are incarcerated. This is health discrimination. Some reforms or legal changes would be necessary to guarantee without future interruption Medicare to prisoners. This would likely require minor legal changes at both the state and federal levels.
Potential for abuse: There are concerns about how a system like Medicare might be abused in the prison system, especially if inmates or prison staff take advantage of the system for non-medical needs. Proper oversight and accountability mechanisms would offset misuse.
Political resistance: Healthcare reform for prisoners perennially faces political resistance. Many lawmakers argue that prisoners do not deserve the same benefits as law-abiding citizens, while others believe reforming the prison healthcare system is a matter of human rights. We believe in universal rights.

Strategies for advocacy

Public awareness campaigns: Educating the public on the realities of healthcare in prisons and the potential benefits of expanding Medicare coverage to prisoners is essential. Highlighting the human rights and cost-effectiveness aspects can sway public opinion.
Building coalitions: Working with organisations that advocate for criminal justice reform, prisoner rights and healthcare access could strengthen advocacy efforts. Coalition-building would help amplify the voices of those who have been directly impacted by inadequate prison healthcare.
Legislative action: Advocating for legislative changes that guarantee prisoners receive Medicare benefits would be key. This involves working with lawmakers who have been supportive of criminal justice reform and health equity.
Data and research: Producing studies and data that show the long-term benefits and cost savings of providing Medicare to prisoners can make a compelling case. Evidence-based advocacy is more likely to influence policy decisions.

Possible legislative reforms

Medicare expansion: Guaranteeing Medicare eligibility to include individuals who are incarcerated would likely require changes to both state and federal laws. Advocates could push for a policy that allows incarcerated people who meet Medicare’s criteria (such as age and disability) to enrol.
Telehealth access: Expanding telehealth options for prisoners could be a cost-effective way to address healthcare needs in prisons, reducing the need for expensive hospital transports and making Medicare more feasible to administer.

We have done significant work on issues like the mental health and physical well-being of prisoners and have campaigned for the introduction of Medicare (and other healthcare programs) in Australian prisons. Our advocacy is rooted in the belief that incarcerated individuals are entitled to the same healthcare rights as any other citizens and that the system needs to do more to address their needs, particularly in terms of mental health and chronic illness.

1. Focus on mental health and suicide prevention
We have been outspoken about the mental health crisis in Australian prisons. We’ve highlighted how prisons often exacerbate pre-existing mental health issues and in many cases, lead to more severe mental health crises and even suicides. Our work has emphasised the need for trauma-informed care and better mental health services for prisoners.

The First Peoples population in Australia is disproportionately affected by the criminal justice system. We have linked mental health issues, poor healthcare access and the over-incarceration of the descendants of the First Peoples, calling for more proactive and compassionate interventions.

2. Addressing healthcare access in prisons
We have worked on campaigns to ensure prisoners have access to proper healthcare, especially in relation to chronic conditions, disability and age-related issues. There are many gaps in the healthcare system within Australian prisons, including long waiting times for treatment and inadequate responses to chronic illnesses.

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3. Focus on prisoners who are the descendants of the First Peoples
Our advocacy recognises the ultra-needs of First Peoples disenfranchised. The challenges faced by prisoners who are of the First Peoples include cultural disconnection, lack of family support and a lack of culturally appropriate healthcare services. Advocating for Medicare in prisons, in this context, is seen as a crucial step in levelling the field and ensuring equal access to medical care, regardless of incarceration.

4. Calls for Medicare access in prisons
We argue that it is a human right for prisoners to receive adequate healthcare, including primary care, hospital services, mental health support and medication. Currently, Australian prisoners are subject to state and territory healthcare provisions, which vary significantly in quality and availability.

The Georgatos' vision is that all prisoners should be entitled to the same level of healthcare coverage as free citizens, ensuring that they are treated with dignity and respect.

In Australia, Medicare is a government-funded healthcare system that provides universal coverage for Australian citizens and permanent residents. However, incarcerated individuals are excluded from receiving Medicare benefits while in prison.

We have called for reforms that would include prisoners in this system, which would not only help address health disparities but also potentially reduce healthcare costs over the long term by preventing more serious health issues.

Key arguments for Medicare in prisons (from the Georgatos’ perspective)

Universal access to healthcare: We argue that healthcare is a fundamental right and that being incarcerated should not strip individuals of their access to essential services like Medicare. By including prisoners in the Medicare system, Australia would be ensuring that incarcerated individuals receive the healthcare they need to maintain or restore their health.
Reducing inequities: Many prisoners come from marginalised backgrounds, and the First Peoples in particular face significant health disparities. By ensuring that prisoners have access to Medicare, these inequities can be addressed. This would include providing access to preventative services, mental health care and treatments for chronic diseases like diabetes or hypertension.
Focus on mental health: A key part of our advocacy is ensuring that prisoners have access to mental health services. The prison population experiences higher rates of mental health issues compared to the general population and there is often a lack of adequate care or attention to these needs. Guaranteeing Medicare in prisons will ensure prisoners receive appropriate psychological support and care.
Ethical and human rights perspective: The Georgatos’ approach is rooted in a human rights framework. We believe that incarcerated individuals, regardless of their crimes, deserve to be treated with dignity and have their healthcare needs met. This approach aligns with the broader movement for prisoner rights, which seeks to improve the treatment of those incarcerated and ensure their basic needs are met.

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Challenges and obstacles

Political resistance: As with any advocacy for prisoner rights, there are significant political challenges. Some may argue that prisoners should not have access to the same healthcare benefits as non-incarcerated citizens. There may be fears of cost increases or concerns over the “entitlement” of prisoners to public resources.
Systemic barriers: Even if Medicare coverage for prisoners were enacted, implementing it within the prison system could face administrative hurdles. The prison healthcare infrastructure would need to be overhauled to integrate with Medicare services but would be wondrously beneficial.

The broader impact of our advocacy

The Georgatos’ advocacy for prisoner healthcare in Australia has the potential to impact broader discussions around criminal justice reform, particularly regarding the health and well-being of incarcerated individuals. Our work is part of a larger movement that emphasises rehabilitation, humane treatment and equity in the criminal justice system.

By highlighting the importance of healthcare access in prisons, we are pushing for reforms that would not only benefit prisoners but could also lead to a more just and equitable society overall. Their call for Medicare in prisons fits within the broader goal of ensuring that all individuals, regardless of their circumstances, have access to basic human rights — especially the right to health.

I have argued that Medicare does not require a major legislative overhaul to be extended to prisoners and that the Federal Health Minister has the authority to make the necessary changes without requiring new laws to be passed by Parliament. This is a key part of our advocacy, as he sees it as a more immediate, pragmatic solution to the issue of healthcare for prisoners in Australia.

In essence, I argue that the current Medicare framework can be interpreted and adjusted by the Federal Health Minister through the regulations of the Health Insurance Act 1973, particularly section 6(1). This would allow the inclusion of prisoners in the Medicare system without requiring a new law to be passed.

Here's a breakdown of our argument.

The key legal framework: The Health Insurance Act 1973

The Health Insurance Act 1973 is the primary piece of legislation governing Australia's Medicare system. In this Act, the Federal Government defines the eligibility criteria for who can receive Medicare services.

Section 6(1) of the Health Insurance Act 1973

This section is crucial because it provides the eligibility criteria for individuals who are entitled to Medicare benefits.

The key part of this section states:

Section 6(1) allows the Minister to define who is eligible for Medicare.

This section is flexible enough to enable the Federal Health Minister to amend the regulations and extend eligibility for Medicare to include prisoners. It does not require a full reform of the Act but instead can be done through regulatory changes that fall within the Health Minister's powers.

The Minister may, by notice in writing, determine that a person is entitled to benefits under this Act in respect of the provision of medical services.

This means that the Federal Health Minister has the power to decide that prisoners, as a group, are entitled to benefits under the Medicare system.

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Why we argue this can be done without legislative change

Regulatory flexibility: We argue that the Health Minister has the power to issue such a determination through the existing framework of Medicare. This regulatory change is more efficient and quicker than waiting for a parliamentary debate or for new legislation to pass.
Precedent for ministerial discretion: The Minister's discretion in this area is not unprecedented. The Health Minister already can make decisions about eligibility in a variety of situations (for example, determining eligibility for certain categories of individuals, like refugees or residents of specific areas). We point to the Ministerial discretion that is built into the Act as a tool that could be used to extend Medicare to prisoners, given that the current law is already flexible and allows for adjustments to eligibility.
Simplicity and efficiency: We argue this path is simpler and faster than waiting for a bill to go through the political process in Parliament, which can take years. If the Health Minister simply amended the regulations, it would guarantee prisoners’ access to Medicare almost immediately.

A path forward

Our argument that the Federal Health Minister can extend Medicare to prisoners without waiting for legislative changes presents a timely and actionable solution to the issue of prison healthcare in Australia. By leveraging the flexibility within the Health Insurance Act 1973, the Government could take immediate action to improve the health and well-being of incarcerated individuals.

This is a significant reform that would not only benefit prisoners but could also help create a more equitable and humane criminal justice system in Australia. It offers a pragmatic path forward that doesn’t rely on the slow process of legislative change but instead uses existing powers to create meaningful impact right away.

A holistic, trauma-informed approach to justice and healthcare has been foundational in shifting the national discourse on these critical issues. Through courageous leadership and persistence, we can reshape the conversation about human dignity, social justice and the role of the state in protecting and supporting the most vulnerable in society.