In Kansas's poor, sick places, hospitals and debt collectors send the ailing to debtor's prison

Kansas is a living laboratory for far-right experimentation with extreme economic cruelty: a state where Medicare expansions were thwarted, where xenophobia has penetrated the state bureaucracy, where a grifty, incompetent lawyer has apologized for slavery and driven women out of his own party, even as neighboring states thrive by tending to the needs of working people, rather than the super-rich.

As Kansas sinks into poverty and ruin, its people are growing ever-sicker: poverty is strongly correlated with poor health outcomes, especially in America, where being poor means you can't afford preventative care, and even more especially in Kansas, where limits on Medicare expansion exclude even very poor people from access to subsidized care.

Enter hospital debt collectors.

Propublica's Lizzie Presser reports from Coffeyville, Kansas, home to Coffeyville Regional Medical Center, the only hospital for 40 miles, now that its rivals have all shut down.

In Coffeyville, magistrate judges are appointed, and need no special training to hold the office. Judge David Casement — a cattle rancher who never studied law — presides over medical debt cases, which he hears quarterly at "debtor's exam" days.

At these proceedings, debt-collectors — who do have law degrees, and whom the judge relies heavily on for legal advice — are allowed to quiz sick people, or the parents or spouses of critically ill or dying people, about their assets and income and to ask the judge to order them to divert what little they have to Coffeyville Regional Medical Center, minus the debt-collector's healthy cut.

But sick, poor people can't always afford to travel to the courthouse: sometimes, it's because they have to go see a specialist (or take their kid or spouse to see one); sometimes it's because they had to sell their car to make a previous debt payment.

When this happens, debt collectors like Michael Hassenplug from Account Recovery Specialists Inc (ARSI) can ask the judge to issue a warrant for the debtor, who is taken to the local jail and hit with $500 in bail. Many can't pay it, and stay in jail (Hassenplug insists that they're not in jail for their debts, but rather for their failure to appear), while others who manage to borrow the $500 often find that it is then surrendered to the hospital and its arm-breakers.

Meanwhile, the debts mount: in addition to punitive, usurious interest, the hospital and its debt-collectors reserve the right to lard on fees, fines and penalties for people who struggle with repayment, so that the poorer you are, the more you come to owe. Miss any of those payments and you might end up in jail — and deeper in debt.

Though debt collection filings are soaring in parts of America, Hassenplug speaks with pride about how he discovered their full potential in Coffeyville long before. A transplant from Kansas City, he was a self-dubbed "four-star fuck-up" who worked his way through law school. He moved to Coffeyville to practice in 1980 and soon earned a reputation as a hard ass. He saw that his firm, Becker, Hildreth, Eastman & Gossard, hadn't capitalized on its collections cases. The lawyers didn't demand sufficient payments, and they rarely followed up on litigation, he said. Where other attorneys saw petty work, Hassenplug saw opportunity.

Hassenplug started collecting for doctors, dentists and veterinarians, but also banks and lumber yards and cities. He recognized that medical providers weren't being compensated for their services, and he was maddened by a "welfare mentality," as he called it, that allowed patients to dodge bills. "Their attitude a lot of times is, 'I'm a single mom and … I'm disabled and,' and the 'and' means 'the rules don't apply to me.' I think the rules apply to everybody," he told me.

He logged his cases in a computer to track them. First with the firm and later in his own practice, he took debtors to court, and he won nearly every time; in about 90% of cases nationally, collectors automatically win when defendants don't appear or contest the case. Hassenplug didn't need to accept $10 monthly payments; he could ask for more, or, in some cases, even garnish a quarter of a debtor's wages. His fee was, and often still is, one-third of what he collects. He asked the court to summon defendants, over and over again. It was the judge's contempt authority that backed him, he said. "It's the only way you can get them into court."

Welcome to Coffeyville, Kansas, where the judge has no law degree, debt collectors get a cut of the bail, and Americans are watching their lives — and liberty — disappear in the pursuit of medical debt collection. [Lizzie Presser/Propublica]