Today, Explained - “This will end when one of us dies”

Episode Date: December 6, 2019

ProPublica’s Lizzie Presser explains why Americans are being jailed for their medical debt. Learn more about your ad choices. Visit podcastchoices.com/adchoices

There's a town in Kansas called Coffeyville. It's named after a guy named James A. Coffey. But I want to tell you about three other people I met there. There's a guy, there's a lawyer, and there's a judge. The guy is named Tress Biggs. And the first time he was arrested, he was out hunting in 2008. His son had been diagnosed with leukemia a year before, and Tress wanted to take him out for some fresh air.

So they went out to a grove, and they were looking for roosting doves, and a game warden came through to check their hunting permits. Tress didn't have a hunting permit, so the warden ran Tress's license, and he found that there was a warrant out for Tress's arrest. Tress was shocked and confused. I couldn't believe it. Why would I have a warrant for my arrest? You know, I didn't do nothing wrong, you know, that I thought of. He didn't understand how he could have broken the law or even when he might have had time to break the law. He was working 70-hour weeks at a lumber yard and on construction sites. And he had never

been to jail before. And it wasn't until the game warden drove him over the county line and got him to the courthouse that he was told that the arrest warrant was for failure to appear in court for a hearing over unpaid medical debt. So Tress was booked. It was scary as hell. I don't know, it just freaked me out, you know, because you had to go in and strip down and they put you in clothes. He was given an orange jumpsuit.

And asked me if I wanted flip-flops or shoes, and I looked at him and said, I want shoes in case I need to run. And he was also told that he was going to have to pay $500 cash bail to get out. He had about $50. It was just scary. You know, when the door shut, it was like knowing you can't get out. You can't go nowhere. You're there. You're done. But he did eventually get a friend to lend him some cash. And when he appeared in court for his bond hearing, that $500 that his friend had lent him was applied to his medical debt. This is actually pretty common in Coffeyville,

and one of the driving forces is the second of the three people I mentioned. The first was Tress, the second is the lawyer, Michael Hasenplug. Michael Hasenplug is the most notorious debt collector in town. He started off working for a law firm, and he started to go through the work that his firm did on collections. And he realized that all the other lawyers at his firm

thought of collections cases as kind of petty work and beneath them. But Michael Hassenplug realized that there was a real opportunity. And by that, he meant that there was a way to make more money. So he goes through his collections cases, he computerizes them. We're in the 80s. He realizes that not only can he sue debtors for non-payment, but he can also then follow up on those lawsuits pretty frequently. So he would start calling debtors to court every couple of months so he could learn of any changes to their finances. And if they weren't paying, but they were working, he realized he could also garnish a quarter of a debtor's wages. And he became really good at this. He started his own firm,

and he was representing cities and banks, and also hospitals and doctors and dentists, even veterinarians. So when I was in Coffeyville this summer, I shattered him a little bit. And there was one case I watched. It wasn't Tress, but Hassanplug was trying to collect a debt from a man who owed a couple thousand dollars for an ambulance bill and interest. And the man was disabled, he was schizophrenic, and he was no longer working.

And he had no income besides food stamps and disability checks. And Hassanplug began to go over his earnings, which he had done many times before. And then he set down his pen and he said, between you and me, you're never going to pay this bill, are you? And the debtor replied, nope, if I had the money, I'd pay it. And Hasenplug looked at him and he smiled and he said, well, this will end when one of us dies. The lawyer's work has thrived largely because of the third of the three people I said I was going to talk about. The first guy was Tress.

The second was the lawyer, Hassanplug. And this is the judge, David Casement. The thing about Judge Casement is that he is a cattle rancher, and he was a cattle rancher when he was appointed as a judge, also in the 80s. He wasn't a lawyer, he had never gone to law school, and he had never taken a course in law. And this is actually somehow quite common in lower level courts across the country. It's a vestige of the 19th century, I think. It was a time when lawyers were scarce, particularly in rural parts of the country. But in some states, it's also a way to cut costs. So he's learning the ropes of becoming a judge, and attorneys are starting to explain to him that judges can hold

debtors in contempt of court if they aren't appearing to their hearings. If a judge holds someone in contempt of court, then they can issue a warrant for their arrest. So debtors wouldn't appear for their hearings. Hassemplug would ask the judge for a warrant. And as long as the debtor had been served with their papers properly, Judge Casement would provide that warrant. And so that's how people with medical debt were regularly and continue to be regularly ending up in jail in Coffeyville.

I want to just get back to Tress. So Tress's arrest in 2008, that wasn't his only arrest. Four years later, he was arrested again. And this time, it was because of an unpaid bill for a radiologist. The attorney who was representing that radiologist was Michael Hassenplug. And Tress had missed two hearings. The same year that he was arrested, that second time,

his family calculated that they had accrued more than $70,000 in medical debt. Tress's wife had had to quit her job to care for their son when he was diagnosed with leukemia, and so they'd become a single-income family. And then Tress's wife had gotten really sick, and she had started having sometimes weekly seizures that wiped her short-income family. And then Tress's wife had gotten really sick, and she had started having sometimes weekly seizures that wiped her short-term memory. I was close to almost $100,000 in medical bills. You were? Yeah, with me, my wife, and all my other kids. Kansas is one of the states that didn't expand Medicaid, and Tress's family earned too much money to qualify for Medicaid

and too little money to afford private insurance. So in 2012, they filed for bankruptcy. And I felt bad because we had to do bankruptcy. I didn't want people to know that I bankrupted, you know, because it just makes me look like not much of a man. Recently, Tress got a job that covered him, but his deductible was $5,000. And so by the time that I met Tress this summer, he'd been sued seven times since 2006. And he still has thousands of dollars in medical debt in collections today. I spent a lot of time in Coffeyville watching medical debt collection days in court.

And the people are visibly sick. They're limping to the dais. They're wearing bandages. I met one guy who was in a wheelchair and he had this wound vacuum that was pumping fluids to his wounds. He had just had a heart attack. And the judge will ask these debtors to take an oath, and he'll make sure that no one is objecting to the alleged debt. And then he'll ask them to stick around and talk with the collections attorneys,

and he'll leave the room. And the debtors, none of them have lawyers. I watched days and days of court. No one came with a lawyer. And we're talking, the first day I got there, I watched about 90 people had been summoned for medical debt in a town of 9,000. And the debtors have no sense of their rights or how to assert their rights. So from my reporting in Coffeyville, what I discovered is that we still do have kinds of debtors' prisons, even though they've been outlawed. Tress's case is one of thousands across the country. Lizzie Presser, you reported this story for ProPublica about Coffeyville, Kansas, where debt collection gets people sent to jail.

But this isn't just a Coffeyville problem. This is definitely not a Coffeyville problem. It's a national one. The rate of medical debt in Coffeyville is actually about average. One in six Americans have medical debt. And Coffeyville seemed like an anomaly even to me. But what I realized is that it's not. So I would talk to consumer protection lawyers and debt collection experts, and I would talk them through everything I was seeing in the courthouse in Coffeyville. And all of them responded that this is how it's working across the country. I imagine many Americans and many people listening to this in America have some sense of medical debt.

But how big of a problem is it in the country? So by some estimates, Americans have more than $80 billion in medical debt. Debt collection is now an $11 billion industry with 8,000 firms nationally. And medical debt makes up almost half of what's collected each year. Did the Affordable Care Act do anything to address medical debt in the United States? So we might think that the ACA has contained medical debt, but it's still pretty unclear whether or not it has. So more than a dozen states didn't expand Medicaid, so we have this health care coverage gap in those states. And then on top of that, when we talk about the ACA, we talk a lot about the expansion of coverage, but we often don't talk about how it didn't contain costs. And now insurers have these enormous deductibles,

like trust is $5,000 deductible, and people simply can't pay them. And managing that kind of debt is hard enough on its own, but on top of that, you got to worry about getting arrested? I think one of the frustrating things about this reporting was that everyone was doing their job. And so I could see this kind of system that was now this well-oiled machine. So you can't pay a hospital bill. That medical debt is passed on to a collection agency. Then that debt's passed to an attorney. And then you have repeated court hearings. And then you miss two and you can be put in jail.

And that's what's been happening in Coffeyville and in courts in pockets across the country. If you can be put in jail, I guess it's surprising that people aren't showing up to these hearings. Why aren't they showing up? Is it because they don't even know that they had these hearings? Sometimes it's because they don't know they have the hearings. Some people live hours away and they're in rural areas where there's no transportation. Or it can be a serious burden for them to take time off of work, especially if they can't take

paid days off work and they need the money. Sometimes the mail is sent to the wrong address or they don't open the piece of paper that's come to their door. But I think fundamentally, a lot of them just didn't understand the consequences of missing a hearing. And even when warrants are issued against them, they often don't even know it. So they can be pulled over in a traffic stop and find out that there's a warrant out and they're going to jail. Tell me more about these sort of self-made judges who are involved in this process, who are chasing down poor people for medical debt. Do they think this is fair? I can't speak to Judge Caseman's motivations or whether or not he sees this as an injustice.

But he didn't want to be putting debtors in jail. The way he saw it, he was doing his job and he was using the law as he understood it. But all of that being said, he did also acknowledge that collections attorneys could use the law to their advantage. Judges will say, you know, I'm just upholding the order of the court. But if that were the case, anyone who paid bail would appear and get their money back. But in most of these cases, when they pay cash bail, and it's cash bail only, that money then is given over to the creditor. And any collection agency that's working on commission gets a cut of that bail. And so you see in that moment that this isn't jail for non-appearance. What lawyers will say is that it functionally looks like jail as a way to collect medical debt.

It's jail to make money. It's jail to pay off a medical bill. So I guess the million-dollar question is, is anyone trying to fix this? Is there even a way to fix this? It's a really tricky question. And one of the problems is that a number of systems are connected here. So even Casement, who's a Republican judge, was telling me that he sees the main fix as changing the entire health care system and making it health care for all. But even if there were some sort of panacea like Medicare for all

or a public option that would give people a way out of creating new medical debt, they would still potentially have tens of thousands, if not hundreds of thousands, in some cases, of dollars worth of medical debt to pay off, right? It's a really good point, and that's definitely the case. I mean, in a lot of states, the statute of limitations for these cases is quite long. So a lot of the people I was meeting in Coffeyville were haunted by debts from a decade ago and debts that were then accruing interest yearly so that their bills had doubled over the last 10 years. Just changing

the health care system isn't going to fix what we have in terms of medical debt right now. What we're seeing is that going to jail for medical debt has become this indirect consequence of unrestrained doctor and hospital prices. People are terrified of going to the hospital. But at the end of the day, they're also not going to stop calling an ambulance just because they're poor. Thanks to Lizzie Presser for providing us audio from her reporting for ProPublica. Her story, which you can find at ProPublica.org, is titled When Medical Debt Collectors Decide Who Gets Arrested. The visuals you'll find there add another dimension to the story. I'm Sean Ramos-Firm. This is Today Explained. Irene Noguchi is the show's executive producer. Afim Shapiro is the engineer. Bridget McCarthy,

Amina Alsadi, and Halima Shah produce the show, along with Noam Hassenfeld, who also does music. The Mysterious Breakmaster Cylinder does the rest of the music, and Olivia Ekstrom does facts. Today Explained is produced in association with Stitcher, and we are part of the Fox Media Podcast Network.