Jailed Over Medical Debt

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S1: Lizzie presser reports for ProPublica. She lives in Brooklyn but she spent a lot of her summer in Kansas in a little town called Coffeyville us is kind of old historic town in southeast Kansas a right over the Oklahoma border.

S2: The downtown is lined with these can gorgeous turn of the century brick buildings but all the old department stores and restaurants and boutiques are shuttered Coffeyville has a poverty rate that’s twice the national average in the last few years. Amazon has shut down a local distribution warehouse John Deere laid off workers too. And the largest employer is an oil refinery and the second largest employer is the hospital.

S3: The hospital is what brought Lizzie here because when the people who live here can’t afford to pay that hospital a lot of the time the hospital takes them to court. So can you describe what it’s like on hearing day when you come in and people are there to figure out what’s happened with their medical debt.

S4: Yeah. So when I went the last Tuesday of July some 90 people had been summoned and this is a town of 9000. Only about 35 showed up and many of the debtors are sick and you can see it there in their pajamas. They are wearing eye patches or bandages. They are limping in one case I saw a guy in a wheelchair who had a wound vacuum pumping so that he could get liquid to his wounds. He had just had a heart attack and he was called in to court.

S5: They sit around for a while and they trade stories and even on my first day there people were trading stories about people they knew who had been to jail they’d been to jail because if you miss a couple of these court appearances a warrant can be issued for your arrest.

S6: And a lot of debtors actually think about it as jail for medical debt even though if you look at it and break it down it’s jail for not appearance. Right. But but the way they see it is like Oh I know these people who’ve gone to jail for medical debt and and they do they know people who have gone to jail after they have been sued for unpaid medical bills the kind of debt these people are struggling with.

S1: It’s common. One in three Americans have a bill that’s gone to collection. And the majority of those bills are medical but debtors prison. It’s been against the law since 1833 which is why Lizzie was sitting in this court. She wanted to know how does this work when the judge walks into this room. What does he tell these people.

S7: The judge asks them to take an oath and then he says to each one of them that then you talk to the collection’s attorney. And after that they are free to go. And then he leaves the room.

S8: He leaves the room. And what you have is essentially a judge’s courtroom. And it’s not on the record and no one in the three weeks I was there had an attorney with them. So these debtors also don’t understand what their rights are or how to assert them and the debt collectors or the collections attorneys are sitting at the front of the room. And it feels as if they are representatives of the court for some debtors.

S9: Today on the show. What three weeks in a small town courthouse in Coffeyville Kansas can tell you about the high price of American health care. What’s happening there may seem extreme. But the truth is there are courthouses like this all over the country. I’m Mary Harris. You’re listening to what next. Stick with us.

S3: When you hear a story about someone who’s landed in court for debt sometimes it’s easy to feel like well that wouldn’t happen to me. But you don’t really know until you’re in it. You don’t really know until your kid get sick and then it’s your family that’s behind on their medical bills. And somewhere along the line a collections agency starts looking out for you. That’s what happened to this guy. Lizzie met in Coffeyville. His name is trust Biggs and he told her the story about how he learned he was behind on his bills in the first place trust.

S4: Biggs is out hunting in 2008 with a bunch of friends and he had taken his son out with him. His son was 6 years old and a year before he had been diagnosed with leukemia. Trust wanted to spend some time with his son and to give him an opportunity to be outside when they’re out hunting they saw a game warden come through and what did the game warden say. They were duck hunting and he wanted to make sure that tress was licensed to be dove hunting. He wasn’t ready to start running and when the warden checked his license he asked trust to step inside his truck and he told Trask that there was a warrant out for his arrest.

S3: Did trust have any reason to think there’d be a warrant out for his arrest.

S10: Travis had no idea why or how that could be a warrant out for his arrest. He’d never been to jail. He’d never been in trouble with the law and it made no sense to him.

S11: So what happened after that.

S12: He he I guess he can’t take his son with him to jail. So what does he do.

S11: Tress steps out of the car and he asks a friend to take his son home to his wife and he gets back in the car and he’s driven actually over the county line to the jailhouse in Montgomery County in Kansas.

S10: And what happens then. He gets fingerprinted and booked into the county jail. Absolutely humiliated. He’s told to strip he’s told to brace himself for a bottle or a tub really of de-listing liquid. And in that process he’s told that the warrant has been issued because he failed to appear in court for a hearing related to medical debt when he heard that.

S3: What did he think.

S10: He was furious and so frustrated and and humiliated and he felt really small and as if this kind of tragedy that had befallen his family wasn’t going to leave him anytime soon. He also didn’t have the money to pay bail. So part of the problem was that when he was booked he was booked on a 500 dollar cash bail bond which meant that he needed to come up with money that he didn’t have. He said he ate about 50 dollars to his name at that point and this is a hardworking man. He was working two jobs. He was working at a lumber yard and on construction sites about 70 hours a week. His wife had had to quit her job to take care of lane full time because that’s what Lane’s doctors had insisted. This is a family in crisis and for the past year the way the family had survived is by focusing on priorities and priorities for Lane’s health. They were feeding the kids it was making sure that there was enough money to keep the electric bills paid and the water the water running the food on the table and they had missed two court dates for their medical debt hearings and that’s what had landed tress in jail.

S3: I wonder if you can explain a little bit how trust got into this situation where he had so much debt.

S4: He made about twenty five thousand dollars a year and in order to be covered by Medicaid he would have needed to make twelve thousand dollars a year. This is for a man supporting a family of six so he couldn’t qualify for Medicaid and he also could not afford private insurance at the time.

S3: Part of what’s interesting to me about your reporting is that he eventually got insurance but you make the point that one of the side effects of the ACA is that the cost of health care has gone up at the individual level at other levels.

S5: Yeah. So I’m not sure that it’s a side effect of the ACA but I think that when we talk about the Affordable Care Act what we don’t talk about is that it did nothing to contain costs. Right. So it absolutely increased the number of people who were covered by insurance across the country but it didn’t contain the costs of health care. So trusts did end up getting insurance private insurance by his employer in the past few years. But he has a five thousand dollar deductible and who can pay 5000 dollars out of pocket. And that was something I was hearing repeatedly in court.

S11: So trust is one person who I spoke with in court. But I spoke with dozens of patients and some of them just simply had deductibles they could not afford. And that meant that when they were hit with a two thousand dollar bill they were falling into the same kind of debt that trusted initially.

S12: But someone like trust Biggs. He’s been in and out of debt collection for his medical bills for more than a decade. He’s tried everything he can to get out from under them. He’s filed for bankruptcy. He’s established payment plans. He’s gotten health insurance but he still can’t afford the bills. But all the time once he thought he was done paying but he got called into court anyway over fees and interest. All these appearances in front of a judge.

S3: You can see how they would pile up become unmanageable.

S5: So one person on one bill can be called in four times a year to do what’s called a debtors exam. And that means that they’re testifying to what they earn and what they own. So that a debt collector can decide what to do with that information. What will happen is a debtor can be called in even if they live two and a half hours away. If they cannot afford childcare to leave their kids at home if they cannot take paid days off of work if they cannot afford to take unpaid days off of work. And so debtors will miss repeated hearings and if they miss two consecutive hearings. They can be put in jail. The judge will say that this is a way to uphold the order of the court. But what ends up happening is that they are given cash there. They are made to pay cash bail. Five dollar cash bail. And if they pay that money which they typically do that money will almost always be applied to their debt. And so the collectors take that cash bail and they take a cut of it. If they are paid on commission as well. And so in that moment you begin to see that this jailing is functionally a way to collect a debt not to make some money to appear. Right.

S3: Bail is typically paid so that once you appear you receive it back so you can see in that description how the debt collection and the justice system are kind of braided together in this way almost inseparable but you can understand too that for a hospital or for a doctor who is owed a lot of money by someone like trust Biggs they’d say I need to get paid somehow. What struck me about your article was that it lays out this system that is functioning completely normally really kind of as designed. Everyone is responding to whatever they’re being incentivized to do. It’s just that when you look at it closely it looks really really unfair.

S5: Well I think your point about medical providers needing to get paid is also a really important one. Right. So I was looking at Coffeyville though the hospital there the Coffeyville Regional Medical Center is the only hospital within about a 40 mile radius. And that’s partly because three nearby hospitals have closed in the past several years. Some of them cite Kansas rejection of Medicaid expansion as as a key cause. So hospitals especially rural hospitals are struggling to stay afloat. And this is one way in which hospitals are trying to recoup costs.

S3: And we should say that if Kansas had expanded Medicaid it would mean a lot more people had coverage it would mean that a place like the hospital in Coffeyville would have a guaranteed income stream and they wouldn’t necessarily be able to bring people in to court or they wouldn’t need to. That’s exactly right. When you spoke to the local hospital about why they aggressively pursued these debts what did they tell you.

S10: The local hospital told me that they are struggling like many rural hospitals and that what they are trying to do is keep their doors open essentially. They also told me that they offer financial assistance and that they have provided over a million dollars in charity care in Coffeyville the orders of the court are determined by one man a judge named David Casement.

S4: So David Casement was appointed as a magistrate judge in the 80s but he had never taken a course in law and didn’t have a law degree. And by the way is that happen. It’s not uncommon in low level courts that you see judges without law degrees. And David Casement was actually a cattle rancher when he started this job. He had never been in a courtroom before and it was attorneys who were telling him that he really did have the power of contempt to put people in jail if they weren’t obeying his orders. And that was one other thing that I found quite startling in my reporting which is that I would sit in the courtroom and if people didn’t appear the judge would turn to the collection’s attorneys and say that’s a bench warrant if you want it.

S13: And when I asked the collections agencies or the collections attorneys you know how do you decide who who is who gets arrested in these cases. They said oh we don’t. That is a decision of the court and the court is just following the process of the law. If someone doesn’t appear they will issue a warrant. So one’s pointing at the other the others pointing at the first. Exactly. And I would go to the judge and say the same thing you know how. How is this working what I’m looking what I’m seeing is that you are saying to the collectors they can have a warrant if they want one. He said That’s right.

S14: And what I’m doing is I’m giving them my blessing.

S3: You spoke to a lawyer to a guy named Michael Hasim plug who shows up in court and he’s one of those guys at the front of the courtroom meeting with defendants. Tell me a little bit about him.

S4: So Michael hasn’t moved to Coffeyville in 1980 and he had worked his way through law school and began working with a firm and at some point early on in the 80s. One of the lawyers who was in charge of collections went on vacation and handed him the collections filings and said look over this will you and have some books says that he did and what he saw was that the firm that he was working for wasn’t doing nearly enough with those collections cases and could be doing a lot more. And he understood that other attorneys kind of thought of collections as beneath them or as petty work. But for him he really identified an opportunity what he saw was that other attorneys have thought of collections as beneath them petty work. And for him he said no this is actually an opportunity to rev up our revenue stream. And he began to computerize their debt collections cases and keep track of them. And when he would litigate he would also then follow up. And so at first he was calling debtors in more frequently than once every three months would call debtors to reappear after he got a judgment according to Judge Casement sometimes monthly and he would make sure that those debtors were coming in repeatedly so that he could tell if there was a change in their financial situation and asked for more.

S3: So the picture I’m getting is that you have a judge who’s a little relaxed and rushing in to kind of fill that power vacuum are lawyers who are very incentivized to collect money. So you know they’re happy to tell the judge hold this person in contempt of court because then once they get in jail I’m going to get a little cut of that bail and they’re happy to show up week after week and work out payment plans because those little bits of money add up for them. Is that accurate.

S4: Yeah I think that’s right. And I think different collections attorneys have different strategies. But Michael has some pluck certainly follows that line. He’s chosen to follow up on litigation in this way so that he’s asking debtors to come to court repeatedly other collections attorneys aren’t necessarily as aggressive.

S3: What if the judge just refused to participate in all this. Like said listen I’m not going to have people be arrested for their medical debt if you can’t pay we’ll work out a payment plan. You don’t have to come four times a year maybe make it once a year. Could he make those kinds of changes.

S4: Absolutely. So the judge has a lot of power and a lot of discretion in these cases which is one of the reasons why focusing on a judge who wasn’t educated in law school I thought was interesting to me because this is common. The judge can decide how frequently they think a debtor should be coming to court. The judge can decide that he or she does not want to use his authority of contempt his contempt authority to. Put someone in jail that is a decision of the court. The judge can decide that he’s not going to require a 500 dollar cash bail. Instead he can say they can sign a sheet of paper and promise to appear in court. The judge has a ton of discretion in these cases.

S15: Does he know that. Yes he is aware of that I guess I’m struggling to figure out the motivation of the judge.

S3: I guess I get the motivation of a lawyer.

S16: They’re making money so I get that in a way I guess what I don’t understand. Is how the judge fits into that because as you’ve said he has so much discretion in this process.

S6: I really liked David Casement. Judge Keyes was a thoughtful clearly gentle man who was who was interested in talking with me about what I was finding and what I found to be problematic. I mean he did not shy away from these very questions that I put to him. He doesn’t want to put debtors in jail. I don’t think the fees. This is some kind of malicious intent. Kansas courts are some of the most underfunded courts in the country. He’s trying to move through a docket as quickly as possible and I think what ends up happening is that the debt collection attorneys end up speeding that up or making it more efficient for him if he gets to kind of cede some of that control.

S3: There was one other detail that really stuck with me which was that this judge who you spoke with who’s a Republican he says listen I don’t know if I want to say this out loud but I think maybe we need some kind of universal health care.

S6: Yeah I mean I think one of the things that he’s realized in this position is that he said very clearly our health care system is not working. If this is my job. And he said to me as a Republican I would probably be hung for saying this but we need health care for everybody. And to be able to contain some of those costs. And so even he felt as if looking at this system really closely he was able to see that. The health care industry the help our healthcare system. As it’s built right now just isn’t going to work and eat and tweaking it around the edges isn’t the answer.

S2: Lizzie presser. Thank you so much for coming in. Thanks so much for having me. Lizzie presser is a reporter for ProPublica.

S17: All right. That’s the show. What next is produced by Mary Wilson Jason de Leone Daniel Hewett And Mara silvers. Once you are done with this show which you are right now I’ve got a suggestion for you going over to the slow burn feed because today they are launching their third season. It’s a whole new idea. It’s a whole new host. It’s gonna be great. It’s all about two back and Biggie. Check it out. I’m Mary Harris. I will talk to you tomorrow.