In pockets of America, patients are going to jail because they can’t afford their medical bills and can’t make repeated court hearings. I spent several weeks reporting on this practice in Coffeyville, where I dug up 30 arrest warrants issued against medical debtors and found that at least 11 people were jailed this year alone.
When hospitals and doctor’s offices can’t recoup payment, many hire debt collectors. In some cases, the medical providers choose to sue, and they are represented by collections attorneys. Defendants can go to jail if they miss two consecutive court hearings. Kansas provides relatively little consumer protection in these cases compared with other states and has not acted to rein in the power of debt collectors in court.
Consumer protection lawyers point to garnishment as one key area for reform. In Kansas, 25% of debtors’ wages can be garnished, as can all funds in a bank account. Some states have protected certain bank funds from garnishment and shielded a greater share of a debtor’s wages. In Texas, for example, all wages are exempt from garnishment in medical debt collection cases.
In addition, once a creditor obtains a judgment against a defendant in Kansas, the debt starts to accumulate interest, at an annual rate of 12%. State legislatures set these rates, and others have set theirs lower. Indiana, for example, caps its rate at 8%.
Kansas law also permits judges to summon debtors to court “from time to time,” which means there’s no cap on the frequency of these hearings after a judgment. In Coffeyville, some nonpaying defendants are called in four times a year, asked to skip work or travel for hours or leave bed rest to attend hearings. Trial courts could clarify these procedures. The Legislature has the power to amend this law, as well.
Jail is the most extreme consequence of these cases. Some judges and debt collectors say that issuing bench warrants for debtors who miss hearings helps uphold the rule of law. But the American Civil Liberties Union, which has conducted the most thorough research on the criminalization of private debt, has urged state legislatures to prohibit courts from issuing warrants for the arrest of a debtor in collection cases.
In Coffeyville, the $500 cash bail paid by debtors is almost always applied to their bills. Experts told me this creates an incentive to sue debtors and request warrants for their arrest. The National Consumer Law Center has called for state laws to ensure that any arrested debtor be given the opportunity to sign a financial affidavit instead of going to jail and having to pay cash bail.
To understand why people fall into medical debt, it’s important to understand coverage.
In Kansas, tens of thousands of residents have been left uninsured by the state’s decision not to expand Medicaid; hospitals that have closed have cited the rejection of Medicaid expansion as a cause. Coffeyville Regional Medical Center has brought the vast majority of medical debt-related lawsuits in Montgomery County. Its attorney Doug Bell told me that the hospital is just trying to keep its doors open.
“The decision of 14 states not to expand Medicaid certainly has had a dramatic effect on the economic liability of small town rural hospitals,” he said.
Lizzie Presser is a reporter with ProPublica, a national journalism nonprofit.